Megaprosthetic reconstruction for periprosthetic or highly comminuted fractures of the hip and knee

Objectives

To present the experience of a tertiary referral hospital in the management of a case series with hip or knee fractures by using modular megaprosthesis.

Patients and methods

Seventeen consecutive patients with highly comminuted fractures of the knee (n = 2), periprosthetic fractures of knee (n = 10) or hip (n = 5) were included. Fractures were managed with modular megaprosthesis (including total hip in 2 cases). Postoperative complications like infection and instability and outcome measures like return to previous mobility and living were recorded.

Results

The mean age at time of surgery was 77 years (25–91), and mean follow-up was 44 months (13–98). We had no intra-operative complications. There were 3 deep periprosthetic infections, 1 hip and 2 knee. In the hip group, including total femur patients, we had 2 dislocations (2/7), both managed with closed reduction. No aseptic loosening was seen. 15/17 patients regained walking ability, and 16 were discharged to independent living. Nine patients have died at the time of follow-up.

Conclusions

In these often old and physically compromised patients with highly comminuted fractures or complicated periprosthetic fractures, modular megaprosthesis could be a good surgical option. It can provide immediate stability and allow early mobilization.