title: Megaprosthetic reconstruction for periprosthetic or highly comminuted fractures of the hip and knee.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Orthopaedic Surgery, Sundsvall Teaching Hospital, 85186, Sundsvall, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Lundh
authors.forename: Arkan S
authors.initials: AS
authors.lastname: Sayed-Noor
authors.forename: Otte
authors.initials: O
authors.lastname: Brosjö
authors.forename: Henrik
authors.initials: H
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome