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Multicenter Study
. 2025 Feb 1;107-B(2):253-260.
doi: 10.1302/0301-620X.107B2.BJJ-2024-0562.R2.

Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study

Andrea Sambri  1 , Domenico A Campanacci  2 , Elisa Pala  3 , Maria A Smolle  4 , Davide M Donati  5 , Michiel A J van de Sande  6 , Oleg Vyrva  7 , Andreas Leithner  4 , Lee Jeys  8 , Pietro Ruggieri  9 , Massimiliano De Paolis  1 ; EMSOS PJI Study Group; EMSOS PJI STUDY GROUP; Michele Fiore  1 , Marta Bortoli  1 , Alessandro Bruschi  1 , Elisabetta Neri  2 , Diogo Catelas  10 , Vania Oliveira  10 , Marko Bergovec  4 , Korhan Özkan  11 , Aykut Çelik  11 , Erhan Okay  11 , Luca Cevolani  5 , Robert V der Wal  6 , Richard Evenhuis  6 , Minna Laitinen  12 , Roman Malik  7 , Andreas Krieg  13 , Paul Jutte  14 , Min W Joo  15   16 , Tariq Azamgarhi  17 , Craig Gerrand  18 , Rob Pollock  18 , Jasprit Kaur  8 , Jonathan Stevenson  8 , Hartej Sur  8 , Guy Morris  8
Affiliations
Multicenter Study

Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study

Andrea Sambri et al. Bone Joint J. .

Abstract

Aims: The aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.

Methods: A retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.

Results: A total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).

Conclusion: This study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.

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Conflict of interest statement

L. Jeys reports consulting fees from Implantcast, unrelated to this study. A. Leithner reports institutional educational grants from Johnson & Johnson, Alphamed, and Medacta, unrelated to this study. P. Ruggieri reports royalties or licenses from Exactech and Stryker, unrelated to this study, and holds unpaid positions as Vice President of EFORT, Secretary General of ISOLS, and is a member of the Board of Directors for the University of Padova. M. A. Smolle reports travel grants from Alphamed Fischer, Implantcast, ImplanTec, and Pharmamar, unrelated to this study. M. A. J. van de Sande reports a department research grant from Implantcast, unrelated to this study, and is also Vice President of EMSOS.

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