Survivorship of Megaprostheses in Revision Hip and Knee Arthroplasty for Septic and Aseptic Indications: A Retrospective, Multicenter Study With Minimum 2-Year Follow-Up.

Abstract

BackgroundThe use of megaprostheses in nononcologic patients has been associated with complication rates greater than 50%. In patients with prior periprosthetic joint infection (PJI) with subsequent two-stage reimplantation, this complication rate may be even higher. This study was to investigate the outcomes of megaprostheses in nononcologic patients undergoing revision hip/knee arthroplasty.MethodsWe retrospectively studied patients who underwent megaprosthesis replacements from 1999 to 2017 at 5 hospitals with minimum 24 months of follow-up. Patients were stratified based on history of prior PJI (septic vs aseptic) and location of the megaprosthesis (the hip or knee). Postoperative complications were classified as soft-tissue failure, aseptic loosening, structural failure, and infection.ResultsOf the 42 patients, 19 were in the septic cohort and 23 were in the aseptic cohort. The overall complication rate was 28.6%. Complication rates for the septic and aseptic cohorts were 32% and 26%, respectively (P = .74). By anatomic location, there were 2 of 13 (15%) and 10 of 29 (34%) complications in the hip and knee groups, respectively (P = .28). In the septic cohort, there were no (0%) complications in the hip group and 6 of 14 (43%) complications in the knee group (P = .13), all due to infection. In the aseptic cohort, there were 2 of 8 (25%) and 4 of 15 (27%) complications in the hip and knee groups, respectively (P = 1.0).ConclusionsThere is no difference in the postoperative complication rates between the septic or aseptic cohorts undergoing revision hip or knee megaprosthesis replacements. In patients with prior PJI, proximal femoral replacements have improved short-term survivorship compared with distal femoral or proximal tibial replacements.