Convened under the auspicious of esteemed endorsers - ISTA

Objective of this study was to analyse results of two stage revisions in infected megaprosthesesin lower limb.Material and methods Between April 1983 and December 2007, 1036 modular uncementedmegaprostheses were implanted in 605 males and 431 females with mean age 33.5 yrs: 160KMFTR ® , 633 HMRS ® prostheses, 68 HMRS ® Rotating Hinge and 175 GMRS ® . Sites: distalfemur 659, proximal tibia 198, proximal femur 145, total femur 25, distal femur and proximaltibia 9. Histology showed 612 osteosarcomas, 113 chondrosarcomas, 72 Ewing’s sarcoma, 31metastatic carcinomas, 89 GCT, 36 MFH,68 other diagnoses.Infection occurred in 80 cases (7.7%) at mean time of 4 yrs (min 1 month, max 19 yrs) in 18KMFTR ® , 47 HMRS ® , 5 HMRS ® Rotating Hinge, 10 GMRS ® . Sites: 51 distal femurs, 21proximal tibias, 6 proximal femurs, 1 total femur and 1 extrarticular knee resection. Mostfrequent bacteria causing infection were: Staphilococcus Epidermidis (39 cases), StaphilococcusAureus (17) and Pseudomonas Aeruginosa (5). Infection occurred postoperatively within 4weeks in 9 cases, early (within 6 months) in 12 cases, late (after 6 months) in 59 cases.Usual surgical treatment was “two stage” (removal of implant, one or more cement spacers withantibiotics, new implant), with antibiotics according with coltures. One stage treatment wasused for immediate postoperative infections, only since 1998.Functional results after treatment of infection were assessed using the MSTS system.Results A two stage revision was attempted in 73 pts (91.2%): in 58 cases a new prostheses wasimplanted (with negative laboratory tests for infection) at mean time of 5 months (min 2, max16 months), but in 3 pts infection recurred and they were amputated; 4 pts died beforeimplanting a new prosthesis; 11 pts were amputated after several spacers since infection did notheal. One stage revision was performed in 4 of the 9 immediate postoperative infections, withsuccessful results.In 3 cases an amputation was primarily performed, to proceed with chemotherapy.Revisions for infection were successful in 63 pts (79%), while 17 pts were amputated (21%).Functional results evaluated in 53 revised cases were good or excellent in 43 (81.1%).Conclusions Two stage treatment of infected megaprostheses is successful in most cases. Onestage has selected indications, mainly in postoperative immediate infections.Saturday, October 9, 2010, 16:00-16:50Session B22: Arthroplasty- Getting it Right!Survival of the Implants in Primary and Secondary Reconstructions WithGMRS® Modular Prostheses for the Lower Limb: Complications,Functional Results and a Comparative Statistical Analysis.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]