Background: Periprosthetic joint infection (PJI) is a severe complication following megaprosthetic reconstruction in musculoskeletal oncology. This study aimed to evaluate outcomes of different surgical strategies for PJI in lower-limb megaprostheses and identify factors associated with treatment failure. Methods: We performed a retrospective cohort study of 29 consecutive patients treated for PJI after oncologic megaprosthetic reconstruction. Reinfection was analyzed using cumulative incidence functions (CIFs) with death treated as a competing event. Overall survival was assessed using Kaplan–Meier analysis. Univariable cause-specific Cox regression was performed for exploratory risk-factor analysis. Results: Among 29 patients, coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated pathogens, and difficult-to-treat organisms were identified in a substantial proportion of cases. In patients managed with two-stage revision, the cumulative incidence of reinfection was 15% (95% CI: 0–30%) at 1 year and 30% (95% CI: 10–50%) at 2 and 5 years. In the DAIR cohort, the cumulative incidence of reinfection was 25% (95% CI: 0–62.5%) at 1 and 2 years and 37.5% (95% CI: 12.2–75%) at 3 years. Positive reimplantation cultures occurred in 38% of cases and were strongly associated with subsequent treatment failure. Polymicrobial infections were present in 27.5% of cases. Amputation was required in 17.2% of patients, often due to multidrug-resistant organisms or poor soft tissue. Conclusions: Two-stage revision remains the most effective strategy for PJI management in megaprostheses. DAIR may control acute infection but is suboptimal for definitive treatment. Individualized, multidisciplinary approaches are essential to improve outcomes in this high-risk population.

Spinal cord injury is strongly associated with male infertility, traditionally attributed to erectile and ejaculatory dysfunction. However, accumulating evidence demonstrates that infertility in this population extends beyond neurogenic impairment and involves profound biochemical and molecular alterations within the male reproductive system. The objective of this review is to synthesize current evidence on the role of oxidative stress, inflammation, and sperm DNA damage as central mechanisms driving impaired fertility in men with spinal cord injury. A comprehensive evaluation of clinical and experimental studies indicates that seminal plasma in affected individuals is characterized by elevated reactive oxygen species, reduced antioxidant capacity, and a pro-inflammatory cytokine profile, including increased levels of tumor necrosis factor alpha, interleukin 6, and interleukin 1 beta. These alterations are closely linked to leukocytospermia, mitochondrial dysfunction, and disruption of the blood–testis barrier, creating a toxic microenvironment that compromises sperm function. As a consequence, spermatozoa exhibit reduced motility, impaired membrane integrity, and significantly increased DNA fragmentation and chromatin abnormalities. Elevated sperm DNA damage has been consistently associated with poor fertilization outcomes, reduced embryo quality, and increased risk of pregnancy loss in assisted reproductive settings. Importantly, these molecular defects persist even when sperm are retrieved using advanced techniques such as electroejaculation or surgical extraction, highlighting the need for targeted therapeutic strategies. Interventions aimed at reducing oxidative stress and modulating inflammation, including antioxidant supplementation and advanced sperm selection methods, show promise but remain insufficiently standardized. Future research should focus on the development of personalized approaches integrating molecular diagnostics and targeted therapies to improve reproductive outcomes in this population. Collectively, this review reframes spinal cord injury-related infertility as a complex inflammatory and oxidative disorder and underscores the importance of addressing sperm DNA integrity in clinical management.