Search papers, labs, and topics across Lattice.
This retrospective study investigated surgical strategies for periprosthetic joint infection (PJI) following oncologic proximal tibia reconstruction (PTR) with megaprostheses or allograft-prosthetic composites. Sixty-one patients were treated with debridement, antibiotics, and implant retention (DAIR), DAIR with modular component exchange (DAIR plus), or two-stage revision. The study found that DAIR plus and two-stage revision had significantly higher reinfection-free survival rates compared to DAIR alone, with DAIR plus showing non-inferior outcomes to two-stage revision in cases with well-fixed stems.
DAIR with modular component exchange offers a viable alternative to two-stage revision for PJI after oncologic proximal tibia reconstruction when the stem is well-fixed, potentially reducing morbidity and complexity.
BACKGROUND While the incidence of periprosthetic joint infection (PJI) after oncologic proximal tibia reconstruction (PTR) is well documented, limited data exists on the clinical course and infection eradication rates after PJI onset. Our study evaluated treatment success and functional outcomes associated with different surgical strategies for PJI after oncologic PTR. METHODS We retrospectively identified patients treated for PJI after oncologic PTR with a megaprosthesis or allograft-prosthetic composite between 1995 and 2023 at two tertiary care institutions. Surgical strategies included debridement, antibiotics, and implant retention (DAIR), DAIR with modular component exchange and stem retention (DAIR plus), and two-stage revision. Reinfection-free survival (RFS) and amputation-free survival were evaluated using Kaplan-Meier analysis. Functional outcomes and quality of life were assessed at last follow-up using the Musculoskeletal Tumor Society (MSTS) and EuroQol (EQ-index) questionnaires. RESULTS Six-month RFS was 22% for DAIR, 66.7% for DAIR plus, and 83.3% for two-stage revision (p = 0.002). At 2 years, DAIR plus and two-stage showed higher RFS compared to DAIR (p < 0.001). Median MSTS was 63.4%, and EQ index 68.4, with no differences between groups. CONCLUSIONS DAIR plus showed non-inferior outcomes compared to two-stage revision and may be a feasible alternative in cases with well-fixed stems. Functional outcomes remain poor. LEVEL OF EVIDENCE Level III.
