title: [Management of complications in megaprostheses].
abstract: BACKGROUND
  Megaprostheses are frequently used after segmental resection of bone sarcomas, bone metastases, and in large osseous defects in revision arthroplasty.
  
  
  OBJECTIVE
  The incidence of the most common complications associated the use of megaprostheses are reported. The management of complications including therapeutic recommendations are described.
  
  
  METHODS
  The current knowledge and our own experience of complication management with the use of megaprostheses are presented.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Complications with the use of megaprostheses can be successfully treated by revision surgery in most cases.
authors.affiliation: Klinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland, Jendrik.hardes@ukmuenster.de.
authors.forename: J
authors.initials: J
authors.lastname: Hardes
authors.forename: H
authors.initials: H
authors.lastname: Ahrens
authors.forename: G
authors.initials: G
authors.lastname: Gosheger
authors.forename: M
authors.initials: M
authors.lastname: Nottrott
authors.forename: R
authors.initials: R
authors.lastname: Dieckmann
authors.forename: M-P
authors.initials: MP
authors.lastname: Henrichs
authors.forename: A
authors.initials: A
authors.lastname: Streitbürger
mesh_terms: D001859:Bone Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D006801:Humans; D007595:Joint Prosthesis / Q000706:statistics & numerical data*; D012516:Osteosarcoma / Q000453:epidemiology* / Q000601:surgery*; D015995:Prevalence; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome