[Infection management of megaimplants]

Abstract

More and more megaprostheses are being implanted - not just injuries or primary and secondary bone tumors, but also the increase in extended bone defects in revision arthroplasty call for the more frequent use of megaimplants. Underlying disease, medication, age, and frequency of surgical procedures give rise to infections which occur in more than 10% of the patients receiving megaprostheses. Size, surface, and design of the implants themselves increase the infection rate.Every year we treat more than 45 patients with periprosthetic infections of megaimplants and large revision prostheses, many of them infected with multi-resistant germs. MRSE and MRSA have been shown to increase the rate of relapses (19%). The treatment strategy continues to consist of multiple steps, and temporary stabilization is achieved either externally with external fixation devices or orthoses or internally with spacers (PMMA, interim implants). To avoid relapsing infections surgeons must rely on anti-infective surface coatings (silver), local drug carriers (collagen, PMMA), and especially soft tissue coverage with local muscle flaps and radical treatment of the bone infection. Amputations, however, cannot be avoided completely; 5% of our patients had to undergo amputations above the knee after infections of megaimplants.Surgery will be required more frequently to treat infections of megaprostheses and increase the medical, nursing, logistic, technological, and financial burden on the patients, surgeons, clinics, and insurance companies.