ALLOGRAFT-PROSTHESIS COMPOSITE FOR MASSIVE FEMORAL LOSS FOLLOWING MDR-PJI

L. Bruni¹, F. Pezone² , M. Alessio-Mazzola² , V. Salini³ , G. Placella³

¹ Vita-Salute San Raffaele University, Milan
² IRCCS San Raffaele Hospital, Milan, Italy
³ Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy

Correspondence to:

Journal of Orthopedics 2026 January-April; 18(1): 42-49
https://doi.org/10.69149/orthopedics/2026v18iss1_6

Received: 12 January 2026 Accepted: 9 February 2026

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Abstract

Massive femoral bone loss following multidrug-resistant periprosthetic joint infection (MDR-PJI) presents a major reconstructive challenge. We report the case of a woman in her late forties who developed multidrug-resistant Staphylococcus epidermidis PJI with associated periprosthetic fracture four years after cemented total hip arthroplasty performed for metastatic breast disease. Management included prosthesis explant, femoral diaphyseal resection, placement of an antibiotic cement-rod spacer, and targeted antimicrobial therapy, which achieved clinical resolution of infection. Definitive reconstruction employed a 23-cm femoral allograft-prosthesis composite with the femoral component cemented within the allograft, and the allograft-host junction spanned by a retrograde locked intramedullary nail, enabling early weight bearing. At nearly two years, imaging showed maintained alignment, progressive allograft incorporation, and no reinfection or junctional failure. This case highlights an extensive Allograft-Prosthesis Composite (APC) with intramedullary load-sharing as a bone-conserving alternative to a megaprosthesis or long-stem revision in the salvage of complex infections.

Keywords: allograft-prosthesis, arthroplasty, femoral bone loss, joint infection, megaprosthesis