A peri-prosthetic joint infection is a feared complication after mega-prosthesis reconstruction of large bone defects. The current study investigates how patients operated with a mega-prosthesis due to sarcoma, metastasis, or trauma, are affected by a deep infection focusing on re-operations, risk for persistent infection, arthrodesis, or subsequent amputation. Time to infection, causative bacterial strains, mode of treatment and length of hospital stay are also reported. A total of 114 patients with 116 prostheses were evaluated, a median of 7.6 years (range 3.8–13.7) after surgery, of which 35 (30%) were re-operated due to a peri-prosthetic infection. Of the infected patients, the prosthesis was still in place in 51%, 37% were amputated, and 9% had an arthrodesis. The infection was persistent in 26% of the infected patients at follow-up. The mean total length of hospital stay was 68 (median 60) days and the mean number of reoperations was 8.9 (median 6.0). The mean length of antibiotic treatment was 340 days (median 183). Coagulase-negative staphylococci and Staphylococcus aureus were the most frequent bacterial agents isolated in deep cultures. No MRSA- or ESBL-producing Enterobacterales were found but vancomycin-resistant Enterococcus faecium was isolated in one patient. In summary, there is a high risk for peri-prosthetic infection in mega-prostheses, resulting in persistent infection or amputation relatively often.

Background: Despite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections. The total number of reoperations has not previously been described, and little is known about the complication rate of mega prostheses used for other indications than primary bone tumours. Questions/purposes: The current retrospective observational study aimed to describe the patient population treated with mega prostheses at Sahlgrenska University Hospital, Sweden, during 14 consecutive years, reports the complications leading to reoperation and the number and type of reoperations for different kinds of complications, and reports on implant survival. Methods: All patients treated with a mega prosthesis, regardless of surgical indication and anatomical location, at Sahlgrenska University Hospital during the period 2006–2019 were identified. The medical records for all patients were reviewed. Data regarding age, sex, diagnosis, site of disease, bone resection length, chemotherapeutical treatment and postoperative complications including infections and oncological outcome, were collected and evaluated. Results: One hundred and fourteen patients treated with 116 mega prostheses were included in the study. The predominant indication for primary surgery with a mega prosthesis was sarcoma of either bone or soft tissue (53.5% of the patients). In total 51 prostheses (44%) did not require any reoperation after the primary surgery. The most common reason for reoperation was infection (22%) followed by soft tissue failure (13%). The risk for prosthetic infection was significantly higher in the group of patients operated due to sarcoma compared with all other indications for surgery regardless of surgical site (p = 0.004). Conclusion: The study reveals a total reoperation rate of 56% after reconstructive surgery using mega prostheses. Despite the high reoperation rates, at the end of the study period, 83% of the patients had still a functioning prosthesis. Therefore, the use of mega prostheses can be considered a reliable method for reconstruction of large bone defects in selected patients. Level of Evidence: Level IV, therapeutic study.

Energy management tools have become essential for high occupancy buildings because they allow building managers to understand their building’s energy efficiency and identify areas of environmental waste. However, a published and customizable energy management tool standardized for all high occupancy buildings currently does not exist, requiring individual companies to spend time and money creating one that more accurately models their building’s energy efficiency. In this project, we developed the prototype Dean Dashboard, a customizable energy management tool that analyzes a building’s energy usage and optimizes the cost to meet a goal of obtaining the Leadership in Energy and Environmental Design (LEED) Operation and Maintenance (O&M) certification. This project uses an M.C. Dean operated-and-maintained facility as the case model. M.C. Dean is a design-build company for mission-critical facilities. The Dean Dashboard is comprised of five key features: exponentially weighted moving average (EWMA) forecasting models, EWMA control charts, energy efficiency metric calculations, a LEED score optimization model, and a system improvement analysis. Through the integration of these features, the dashboard provides detailed insights into a building’s energy consumption and provides recommendations for how the building can improve its energy efficiency.

Aims: To explore the lived experiences of patients with periprosthetic infection in a mega prosthesis reconstruction after sarcoma resection. Methods: Sarcoma patients treated between January 2016 and May 2023 with a surgical bone sarcoma resection and reconstruction with a mega prosthesis and a subsequent treatment for a deep periprosthetic infection, at one of three sarcoma centres in Sweden, were enrolled post-completion of sarcoma and infection therapies. Data were collected using semi-structured interviews, verbatim transcribed, and analyzed using a qualitative phenomenological method. The interviews were conducted from November 2022 to November 2023. Results: Eight interviews, lasting 33 to 68 minutes, were conducted. Seven participants (three females) with a mean age of 29 years (22 to 59), were interviewed once. One participant experienced a reinfection, necessitating a second interview. The study’s findings indicate that participants lacked awareness of periprosthetic infection risk and severity, with concerns regarding tumour recurrence outweighing these risks. Infection treatment was described as more tolerable than the tumour treatment. Despite positive previous encounters with medical personnel, the hospital, the same as for the cancer treatment, evoked negative emotional responses. All participants reported a decline in joint function post-infection compared with pre-infection, and all experienced changes in their self-perception. Conclusion: Improvements are needed in the communication of potential complications related to bone reconstruction; patients exhibit significant anxiety regarding tumour recurrence; and the patient’s relationship with medical personnel and family significantly influences their ability to manage further extensive medical treatment. Cite this article: Bone Jt Open 2025;7(1):3–8.