Infection of a Total Femur Megaprosthesis: A Retrospective Study of Clinical and Functional Outcomes

Introduction: Infection associated with total femur megaprostheses represents an uncommon and highly complex clinical scenario, typically occurring in patients with multiple previous surgeries and massive bone loss. Evidence regarding outcomes in non-oncologic indications remains limited. Methods: A retrospective study was conducted, including patients treated with total femur megaprosthesis for prosthetic joint infection at Hospital Universitari i Politècnic La Fe, a tertiary referral center in Valencia, Spain, between 2016 and 2023. Clinical, microbiological, and outcome data were collected from medical records. An exploratory analysis was performed, comparing patients with favorable and unfavorable outcomes using non-parametric tests. Results: Ten patients were included, with a mean age of 69 years and a median of six previous surgical procedures. Comorbidities included diabetes mellitus (30%), immunosuppression (40%), and rheumatic disease (20%). The microbiological spectrum was heterogeneous, with Staphylococcus epidermidis identified in 50% of cases and polymicrobial infections in 40%. Candida species and Pseudomonas aeruginosa were each identified in 20% of patients. Complications occurred in seven patients (70%), most commonly reinfection and instability. At the final follow-up, eight patients (80%) required walking aids. Two patients (20%) died from causes not directly related to infection. Conclusions: Total femur megaprosthesis in septic settings is a salvage procedure that may allow limb preservation in highly complex patients, although it is associated with a high complication rate and limited functional outcomes. Its use should be restricted to selected cases and specialized centers. Further multicenter studies are needed to optimize patient selection and management strategies.