Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series
Periprosthetic joint infections (PJI) and fracture-related infections (FRI) of the distal femur (DF) may result in massive bone defects. Treatment options include articulated silver-coated (SC) megaprosthesis (MP) in the context of a two-stage protocol. However, there is limited evidence in the lite...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6679 |
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| author | Michele Fiore Andrea Sambri Lorenzo Morante Marta Bortoli Stefania Claudia Parisi Francesco Panzavolta Domenico Alesi Elisabetta Neri Maria Pia Neri Sara Tedeschi Eleonora Zamparini Luca Cevolani Davide Maria Donati Pierluigi Viale Domenico Andrea Campanacci Stefano Zaffagnini Massimiliano De Paolis |
| author_facet | Michele Fiore Andrea Sambri Lorenzo Morante Marta Bortoli Stefania Claudia Parisi Francesco Panzavolta Domenico Alesi Elisabetta Neri Maria Pia Neri Sara Tedeschi Eleonora Zamparini Luca Cevolani Davide Maria Donati Pierluigi Viale Domenico Andrea Campanacci Stefano Zaffagnini Massimiliano De Paolis |
| author_sort | Michele Fiore |
| collection | DOAJ |
| description | Periprosthetic joint infections (PJI) and fracture-related infections (FRI) of the distal femur (DF) may result in massive bone defects. Treatment options include articulated silver-coated (SC) megaprosthesis (MP) in the context of a two-stage protocol. However, there is limited evidence in the literature on this topic. A retrospective review of the prospectively maintained databases of three Institutions was performed. Forty-five patients were included. The mean follow-up time was 43 ± 17.1 months. Eight (17.8%) patients had a recurrent infection. The estimated recurrence-free survival rate was 91.1% (93.5% PJI vs. 85.7% FRI) 2 years following MP implantation, and 75.7% (83.2% PJI vs. 64.3% FRI; <i>p</i> = 0.253) after 5 years. No statistically relevant difference was found according to the initial diagnosis (PJI vs. FRI). Among possible risk factors, only resection length was found to significantly worsen the outcomes in terms of infection control (<i>p</i> = 0.031). A total of eight complications not related to infection were found after reimplantation, but only five of them required further surgery. Above-the-knee amputation was performed in two cases (4.4%), both for reinfection. Articulated DF SC MP in a two-stage protocol is a safe and effective treatment for chronic knee infection with severe bone loss. |
| first_indexed | 2024-03-10T21:10:23Z |
| format | Article |
| id | doaj.art-f787940d214e4a7f874666a1dd4fdaeb |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:10:23Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-f787940d214e4a7f874666a1dd4fdaeb2023-11-19T16:54:29ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220667910.3390/jcm12206679Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case SeriesMichele Fiore0Andrea Sambri1Lorenzo Morante2Marta Bortoli3Stefania Claudia Parisi4Francesco Panzavolta5Domenico Alesi6Elisabetta Neri7Maria Pia Neri8Sara Tedeschi9Eleonora Zamparini10Luca Cevolani11Davide Maria Donati12Pierluigi Viale13Domenico Andrea Campanacci14Stefano Zaffagnini15Massimiliano De Paolis16Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalySecond Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyOrthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, ItalySecond Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyInfectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyThird Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyThird Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyOrthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, ItalySecond Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyPeriprosthetic joint infections (PJI) and fracture-related infections (FRI) of the distal femur (DF) may result in massive bone defects. Treatment options include articulated silver-coated (SC) megaprosthesis (MP) in the context of a two-stage protocol. However, there is limited evidence in the literature on this topic. A retrospective review of the prospectively maintained databases of three Institutions was performed. Forty-five patients were included. The mean follow-up time was 43 ± 17.1 months. Eight (17.8%) patients had a recurrent infection. The estimated recurrence-free survival rate was 91.1% (93.5% PJI vs. 85.7% FRI) 2 years following MP implantation, and 75.7% (83.2% PJI vs. 64.3% FRI; <i>p</i> = 0.253) after 5 years. No statistically relevant difference was found according to the initial diagnosis (PJI vs. FRI). Among possible risk factors, only resection length was found to significantly worsen the outcomes in terms of infection control (<i>p</i> = 0.031). A total of eight complications not related to infection were found after reimplantation, but only five of them required further surgery. Above-the-knee amputation was performed in two cases (4.4%), both for reinfection. Articulated DF SC MP in a two-stage protocol is a safe and effective treatment for chronic knee infection with severe bone loss.https://www.mdpi.com/2077-0383/12/20/6679orthopedic surgerymegaprosthesisdistal femursilver coatingperiprosthetic joint infectionsfracture-related infections |
| spellingShingle | Michele Fiore Andrea Sambri Lorenzo Morante Marta Bortoli Stefania Claudia Parisi Francesco Panzavolta Domenico Alesi Elisabetta Neri Maria Pia Neri Sara Tedeschi Eleonora Zamparini Luca Cevolani Davide Maria Donati Pierluigi Viale Domenico Andrea Campanacci Stefano Zaffagnini Massimiliano De Paolis Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series Journal of Clinical Medicine orthopedic surgery megaprosthesis distal femur silver coating periprosthetic joint infections fracture-related infections |
| title | Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series |
| title_full | Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series |
| title_fullStr | Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series |
| title_full_unstemmed | Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series |
| title_short | Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series |
| title_sort | silver coated distal femur megaprosthesis in chronic infections with severe bone loss a multicentre case series |
| topic | orthopedic surgery megaprosthesis distal femur silver coating periprosthetic joint infections fracture-related infections |
| url | https://www.mdpi.com/2077-0383/12/20/6679 |
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