![]() Additionally, they may also receive adjuvant chemo-radiotherapy, and have extended operating times. Oncological patients commonly require extensive soft-tissue resections, which is a key contributor to increased infection risk. There is significant heterogeneity between these two cohorts, which must be considered separately. A number of studies have evaluated these outcomes in oncological patients, however there is limited data in non-oncological cases. The relatively low prevalence of megaprostheses leads to a paucity of data surrounding treatment strategies and their outcomes for PJI. Alternatively, DAIR is an accepted treatment for acute infections, and often first-line management in PJI, but its use in megaprostheses has not yet widely been explored. In megaprostheses, the complex nature of massive bone loss, deadspace, and soft tissue cover, create an exponentially greater challenge, for which two-stage revision may be too great an undertaking both technically for the surgeon and physiologically for the patient. Two-stage revision is the benchmark treatment strategy for PJI in conventional arthroplasty, but comes with significant physiological demands, morbidity, and financial costs. Treatment strategies to combat PJI range from surgical debridement and irrigation with implant retention (DAIR – Debridement, Antibiotics, and Implant Retention), to single-stage or two-stage revision, to amputation. ![]() Periprosthetic joint infection (PJI) has a low incidence of 1–2% in conventional arthroplasty, but remains a potentially devastating complication with implications on both patient and surgeon Comparatively, infection rates are significantly higher in lower extremity megaprostheses, with incidences between 3 and 19.5%, with some studies reporting as high as 43% in previously infected megaprostheses. However, in this manuscript, discussion is limited to femoral implants. Relative to the hip and knee, megaprostheses would include proximal-, distal-, and total femoral replacements, in addition to proximal tibial replacements. Megaprostheses are established implants in oncological settings, whereas their use in trauma and revision arthroplasty is growing. Their use in the lower extremity has transformed the functional prognosis of a patient through limb salvage and immediate postoperative weightbearing, where previously they may have undergone amputation for the same pathology. Managing Work Collections of actionable tips, guides, and templates to help improve the way you work.Megaprostheses are increasingly utilised to manage significant bone loss secondary to trauma, revision arthroplasty, and malignancy.Solution Center Move faster with templates, integrations, and more.Events Explore upcoming events and webinars.Content Center Get actionable news, articles, reports, and release notes.Partners Find a partner or join our award-winning program.Professional Services Get expert help to deliver end-to-end business solutions.Technical Support Get expert coaching, deep technical support and guidance.Help Center Get answers to common questions or open up a support case.Smartsheet University Access eLearning, Instructor-led training, and certification.Community Find answers, learn best practices, or ask a question.Learning Center Find tutorials, help articles & webinars.A quarterly roundup of the innovations that’ll make your work life easier. What’s up next A sneak peek at upcoming enhancements.Digital asset management Manage and distribute assets, and see how they perform.Resource management Find the best project team and forecast resourcing needs.Intelligent workflows Automate business processes across systems.Governance & administration Configure and manage global controls and settings.Streamlined business apps Build easy-to-navigate business apps in minutes.Integrations Work smarter and more efficiently by sharing information across platforms.Secure request management Streamline requests, process ticketing, and more.Portfolio management at scale Deliver project consistency and visibility at scale.Content management Organize, manage, and review content production.Workflow automation Quickly automate repetitive tasks and processes.Team collaboration Connect everyone on one collaborative platform.Smartsheet platform Learn how the Smartsheet platform for dynamic work offers a robust set of capabilities to empower everyone to manage projects, automate workflows, and rapidly build solutions at scale.
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