Characteristics and outcome of infections associated with tumor endoprostheses

Hardes, Jendrik; Gebert, Carsten; Schwappach, Anna; Ahrens, H.; Streitbürger, Arne; Winkelmann, Winfried; Gosheger, Georg

doi:10.1007/s00402-005-0009-1

Cited by 144 publications

(125 citation statements)

References 29 publications

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“…Importantly, two-stage revision surgery and even amputation were not necessary in any of the patients in the silver group, whereas these procedures were almost always performed in the titanium group. The literature also includes many studies describing a high percentage of two-stage revision surgery or even amputation in 19-46% of cases [5][6][7]27]. As in the present study, Jeys et al [6] and Myers et al [7] also found that the risk for secondary amputation due to infection was highest in proximal tibia replacements.…”

Section: Discussionsupporting

confidence: 73%

“…Despite advances in endoprosthetic design that have led to lower complication rates, particularly with regard to mechanical failure and aseptic loosening [1], periprosthetic infection of megaprostheses continues to be a common and serious complication in orthopedic oncology [5][6][7]. Currently, it is not possible to avoid periprosthetic infection completely, despite the use of systemic antibiotic treatment, operating rooms with laminar airflow, and routine screening for methicillin-resistant Staphylococcus aureus (MRSA).…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, it is not possible to eradicate the biofilm-producing bacteria from the prosthetic surface, and removing the medical device is the only way to resolve the infection [4]. When there are concomitant poor softtissue conditions, secondary amputation is sometimes inevitable [5][6][7]. Preventing periprosthetic infection is therefore of the utmost importance.…”

Section: Introductionmentioning

confidence: 99%

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Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Hardes

Eiff

Streitbuerger

et al. 2010

Journal of Surgical Oncology

299

216

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Background and Objectives: The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection. Methods: The infection rate in 51 patients with sarcoma (proximal femur, n ¼ 22; proximal tibia, n ¼ 29) who underwent placement of a silver-coated megaprosthesis was assessed prospectively over a 5-year period, along with the treatment administered for infection. The infection rate was compared with the data for 74 patients in whom an uncoated titanium megaprosthesis (proximal femur, n ¼ 33; proximal tibia, n ¼ 41) was implanted. Results: The infection rate was substantially reduced from 17.6% in the titanium to 5.9% in the silver group. Whereas 38.5% of patients in the titanium group ultimately had to undergo amputation when periprosthetic infection developed, these mutilating surgical procedures were not necessary in the study group. Conclusions: The use of silver-coated prostheses reduced the infection rate in the medium term. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Hardes

Eiff

Streitbuerger

et al. 2010

Journal of Surgical Oncology

299

216

View full text Add to dashboard Cite

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“…Alternative treatments have been associated with dislocation, infection, nonunion, and disease progression, often requiring reoperation. Intraoperative complications such as hypotension, oxygen desaturation, embolization, and cardiac arrest have also been reported [2,9,12,22,24,[26][27][28]. Of note, Barwood et al [4] reported acute oxygen desaturation and hypertension in 11 of 45 patients treated with intramedullary nail fixation for metastatic tumors of the femur with actual or impending fractures.…”

Section: Discussionmentioning

confidence: 99%

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

Peterson

Decilveo

O'Connor

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty.Questions/purposes This study examines survival, functional outcomes, and complications associated with long stem hemiarthroplasty in a small group of patients treated for impending and actual pathologic fractures of the proximal femur resulting from metastatic bone disease. Methods Between 2012 and 2015, 21 patients were treated with long stem cemented hemiarthroplasty in 22 limbs. During that time, indications for this approach included lesions from metastases, myeloma, or lymphoma involving the proximal femur that resulted in an impending or actual pathological fracture. An impending fracture was classified as a painful lesion with at least 50% cortical erosion. During the study period, six patients with proximal femoral metastases not deemed to meet these indications were treated with other surgical approaches such as intramedullary nailing supplemented with polymethylmethacrylate and osteosynthesis with a plate-screw construct and polymethylmethacrylate. Mortality was tracked through medical records and phone calls to the patients and their families. Followup for the entire group of patients (n = 22) ranged from 1 to 27 months with a mean duration of 11 months. For patients with at least 1 year of followup (n = 11), the mean duration was 18 months (range, 12-27 months) and for patients with less than 1 year of followup (n = 11), the mean duration was 3 months (range, 1-11 months). Functional outcomes were evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system for lower extremities, the Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status, and the Karnofsky Performance Scale (KPS) Index. Scores and complications were determined by direct patient examination, retrospective chart review, review of a longitudinally maintained institutional database, and followup phone calls. Results Ten patients died of disease within the followup period. Before surgery, the median total MSTS score for the entire group of patients (n = 22) was 4.5 (range, 0-23), Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Clinical O...

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“…Using the rhomboid-shaped incision as originally described, it is often impossible to exactly match the incisions. Specific complications of this incision include harm to soft tissues, wound healing complications, and unfavorable cosmetic results [4,5,7,9,12]. In addition, this technique requires much experience to perform the correct incisions to perfectly match the circumferences.…”

Section: Discussionmentioning

confidence: 99%

A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

Ossendorf

Exner

Fuchs

2010

Clinical Orthopaedics &Amp; Related Research

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Rotationplasty provides stable and durable biologic reconstruction after tumor resection around the knee and renders reliable results, in young patients. However, after resection of the tumor, there is often a mismatch between the circumference of the proximal (femoral) and the distal (tibial) parts. Because rotationplasty includes an intercalary amputation where the ends are readapted, there is always a mismatch of the proximal and distal circumferences of the soft tissue envelope. To facilitate skin closure without tension and to avoid impaired wound healing and subsequent infections, the type of incision is critical and must be carefully planned. We present a new incision technique for rotationplasty about the knee. Half of the difference of the incision length of the proximal and distal circumferences represents the base of the triangle proximally, medially and laterally of the thigh. After adapting both ends, the peak of this flat triangle is distally adapted via a vertical incision which allows it to match unequal circumferences. This technique was used in eight patients, in all of whom the wounds healed uneventfully.

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Characteristics and outcome of infections associated with tumor endoprostheses

Cited by 144 publications

References 29 publications

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

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