Proximal Femoral Reconstruction with Silver-coated Megaprostheses in Nononcological Patients

included in this study were treated with Link Megasystem-C PorAg prostheses.The purpose of this study was to investigate: The general complication rate and revision-free survival of the implant. The efficacy of silver-coated implant in reducing PJI. MethodsThe retrospective study was conducted in accordance with the declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of IRCCS Ist.Ortopedico Rizzoli (Approval Number: 0005704).This retrospective analysis included 16 patients who underwent proximal femoral reconstruction (PFR) using the Megasystem-C ProAg prosthesis (Link Orthopedics). IntroductIonAs the number of primary hip arthroplasties increases, the incidence of revision total hip arthroplasties (THA) is expected to increase in the future. 1,2These revision surgeries often result in significant femoral bone loss, which can also stem from complications such as periprosthetic joint infections (PJIs), aseptic loosening, periprosthetic fractures, poor bone quality due to osteoporosis, failed fixation, trauma, or nonunion.The Paprosky classification remains a standard method for evaluating femoral bone defects and guiding surgical decisions.In cases with excessive bone loss classified as Paprosky IIIa, IIIb, or IV-where both the metaphyseal and diaphyseal bone are severely compromised-standard modular revision stems may fail to achieve sufficient stability.These implants rely on adequate diaphyseal bone for fixation, which is often lacking in such scenarios.In these complex cases, megaprosthetic implants represent an effective alternative due to their ability to provide immediate structural support.Initially developed for oncologic limb salvage following tumor resections, megaprostheses (MP) are increasingly used in nononcologic settings as well.They facilitate early mobilization by offering mechanical stability without requiring bone ingrowth.However, PJI remains a major complication in these procedures, with reported rates as high as 50% in some cohorts. 3To counter this, silver-coated MP have been introduced, aiming to reduce infection rates by inhibiting bacterial colonization and biofilm formationfactors particularly critical in patients with prior infections or multiple revisions. 3,4Infection rates remain variable and can reach up to 19% in proximal femur megaprosthetic reconstructions. 5,6 All patients