Megaprostheses for limb salvage linked to high complication risk, elevated revision rate
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Key takeaways:
- Complications occurred in 33.7% of patients who received a megaprosthesis.
- Distal femoral replacements had a higher 5-year mortality rate at around 23% vs. proximal femoral and total femoral replacements.
LAS VEGAS — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed the use of megaprosthesis for non-oncologic limb salvage yielded significant complication risk and an elevated revision rate at 5 years.
“Overall, megaprosthetics clearly trail behind other forms of revision in arthroplasty and augments with high rates of subsequent revision and complications,” Victoria Oladipo, BS, said in her presentation here. “However, this might still be good for people of certain populations, and they can delay or possibly even avoid limb-sacrificing or joint-sacrificing procedures.”
Oladipo and colleagues retrospectively reviewed data for patients who underwent revision total joint arthroplasty with a megaprosthesis during a 17-year period.
“Given the broad range of dates and higher mortality rate, given the older population, we had to do a competing risk analysis to control for death as an impeding risk,” Oladipo said.
Among 83 patients who received a megaprosthetic implant, Oladipo said patients with distal femoral replacements had a slightly shorter follow-up and a higher 5-year mortality rate at around 23% compared with proximal femoral and total femoral replacements.
“The most common reason for a patient needing a megaprosthetic implant was either periprosthetic fracture or recurrent infections that resulted in severe bone loss,” Oladipo said.
Oladipo noted 33.7% of patients experienced a complication, with many patients presenting with compound or repeat complications.
“Ironically, the most common reason for complication was fracture or infection, which was the most common indication for getting the implant in the first place,” Oladipo said.
The reoperation rate was high in the first 3 months postoperatively, and implant revision steadily increased after 3 months and remained steady, according to Oladipo. She added an implant revision rate of 20% among distal femoral replacements, 50% among proximal femoral replacements and 30% among total femoral replacements at 5 years.
“Most of the mortality happened after this 5-year period, which lets me know that a lot of the patients did not outlive their implants,” Oladipo said.
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Oladipo V, et al. Paper 224. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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