Management of Complications in Megaprostheses

Megaprostheses are frequently used after segmental resection of bone sarcomas, bone metastases, and in large osseous defects in revision arthroplasty. The incidence of the most common complications associated the use of megaprostheses are reported. The management of complications including therapeutic recommendations are described. The current knowledge and our own experience of complication management with the use of megaprostheses are presented. Prospective, randomized studies or meta-analyses on this topic are lacking. An analysis of the literature shows that beside the occurrence of a local recurrence, periprosthetic infection remains the most serious complication. Two-stage revision remains the gold standard, but a single-stage exchange of the prosthesis without removing the stems might be possible in selected cases. Infection is associated with a higher risk of secondary amputation. In contrast, mechanical failures (e.g., wear of the bushings in knee replacements and aseptic loosening of the stems) can be treated more easily. Dislocation of a proximal femur replacement can mostly be prevented by using bi- or tripolar cups. Complications with the use of megaprostheses can be successfully treated by revision surgery in most cases.