[Management of complications in megaprostheses]

Abstract

Background: Megaprostheses are frequently used after segmental resection of bone sarcomas, bone metastases, and in large osseous defects in revision arthroplasty.

Objectives: The incidence of the most common complications associated the use of megaprostheses are reported. The management of complications including therapeutic recommendations are described.

Materials and methods: The current knowledge and our own experience of complication management with the use of megaprostheses are presented.

Results: Prospective, randomized studies or meta-analyses on this topic are lacking. An analysis of the literature shows that beside the occurrence of a local recurrence, periprosthetic infection remains the most serious complication. Two-stage revision remains the gold standard, but a single-stage exchange of the prosthesis without removing the stems might be possible in selected cases. Infection is associated with a higher risk of secondary amputation. In contrast, mechanical failures (e.g., wear of the bushings in knee replacements and aseptic loosening of the stems) can be treated more easily. Dislocation of a proximal femur replacement can mostly be prevented by using bi- or tripolar cups.

Conclusions: Complications with the use of megaprostheses can be successfully treated by revision surgery in most cases.