Deep infection in tumor endoprosthesis around the knee: a multi-institutional study by the Japanese musculoskeletal oncology group

Abstract

BackgroundThe incidence of endoprosthesis failure has been well studied, but few studies have described the clinical characteristics of deep infection in tumor prostheses. This study aimed to analyze the characteristics of deep infection in tumor endoprostheses around the knee.MethodsWe analyzed clinical data of 57 patients with deep infections involving tumor endoprostheses around the knee enrolled from the Japanese Musculoskeletal Oncology Group. Profile of clinical presentation including time between surgery and infection, initial symptoms/blood tests and microbial cultures was evaluated. In addition pre-, intra-, and postoperative clinical factors influencing clinical presentation and treatment outcomes of infections were analyzed.ResultsMean interval between the initial operation and diagnosis was 13 months, and mean time required for infection control was 12 months. The most common pathogen was Staphylococcus. Infection control rates were significantly higher when prostheses were removed rather than salvaged. Ten-year prosthesis survival and limb salvage rates were 41.6% and 75.6%, respectively. Analysis of underlying clinical factors suggested that soft-tissue condition significantly influenced the duration of the infection control period and likelihood of limb salvage.ConclusionsInfection control is a prolonged process. Deep infection frequently results in amputation or prosthesis loss. Intensive analysis of clinical characteristics may aid infection control.

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

“…Whereas a lower incidence of infection in proximal femur reconstructions is what we expected on the basis of most previous experience [9,13,28,30], a less predictable result was an equivalent (even slightly higher) incidence of infections both in the distal femur and proximal tibia reconstructions. The proximal tibia in fact is usually considered at highest risk for septic complications [18,24,27,29]. Dislocation in our series was confirmed to be a major issue in proximal femur reconstructions.…”

“…When compared with conventional prostheses used in total joint arthroplasty for arthritis, a consistently higher rate of complications has been reported with modular megaprostheses, particularly resulting from infection, wear or breakage of prosthetic components, and stem loosening [1,3,11,12,17,19,27,28,[34][35][36][37][38]. The higher infection rate is believed to be the result of prolonged surgical times and large soft tissue exposure in oncologic resections and to a higher risk of contamination in revision and posttraumatic cases.…”

Limb Salvage Surgery for Bone Tumors around the Knee: The Oncological and Functional Outcome—King Hussein Medical Center Experience

“…In the literature, the rate of deep infection has ranges from 3%-10% [1, 11,13,23,24]. Removal of the endoprosthesis, curettage, debridement, irrigation and filling the gaps with spacers for 3 months and reinsertion of the endoprosthesis again were performed in three patients; in two patients we had unsatisfactory final results: amputation following local recurrence in one patient and knee ankyloses in the other patient.…”

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

“…After surgery, femur reconstruction is primarily realized with megaprostheses to gain stable function and facilitate returning to social life [8]. However, there are various risks of these megaprostheses such as aseptic loosening, tumor progression, soft-tissue failures, infection and structural failures that may require revision or finally amputation of the extremity [9,10]. The majority of structural failures are established as fractures and may go unnoticed intraoperatively and often occur at the distal third of the femur [11].…”