Efficacy of different revision procedures for infected megaprostheses in musculoskeletal tumour surgery of the lower limb

Sigmund, Irene Katharina; Gamper, Jutta; Weber, Christine; Holinka, Johannes; Panotopoulos, Joannis; Funovics, Philipp T.; Windhager, Reinhard

doi:10.1371/journal.pone.0200304

Cited by 32 publications

(28 citation statements)

References 33 publications

(44 reference statements)

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“…Periprosthetic infection is a major postoperative complication of prosthesis. Tumor prosthesis has been shown to have a much higher postoperative infection rate (8%–15%) [ 10 , 19 , 21 ] compared with routine total joint replacements such as total hip arthroplasty and total knee arthroplasty (1%–2%) [ 22 ]. Similar to previous studies, deep periprosthetic infection was found and treated in 14 (12%) of 121 patients in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to previous studies, deep periprosthetic infection was found and treated in 14 (12%) of 121 patients in our cohort. Treatment of deep periprosthetic infection has been reported as either a one-stage revision or two-stage revision, and two-stage revision has demonstrated a lower incidence of reinfection [ 10 , 19 , 23 , 24 , 25 , 26 ]. Our series has also shown that only five patients (36%) could be controlled by one-stage revision; the other patients required multiple or additional surgery such as two-stage revision and musculocutaneous flap.…”

Section: Discussionmentioning

confidence: 99%

“…Silver- and iodine-coated implants have exhibited good outcomes in preventing periprosthetic infection [ 7 , 17 , 19 , 27 , 37 ]. As both coated implants could reduce the risk of infection and prevent periprosthetic infection in higher-risk patients, coated implants should be used for patients with high risk factors, including male, soft-tissue sarcoma, predicted prolonged operative time, and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the lower extremity was the most frequent developmental location of musculoskeletal tumors [ 18 ] and hence focusing on the tumor prosthesis of the lower limb was important to elucidate risk factors of periprosthetic infection of tumor prosthesis. Several studies have recommended that two-stage revision is more successful than one-stage revision or debridement for the treatment of an infected prosthesis [ 9 , 10 , 19 ]. In contrast, the two-stage revision procedure is extremely difficult and results in low bone stock and less covered soft-tissue.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Fujiwara

Ebihara

Kitade

et al. 2020

JCM

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Tumor prostheses for the lower limb following resection of musculoskeletal tumors is useful limb salvage management; however, as compared with routine total joint replacement, an increased incidence of deep periprosthetic infection of tumor prosthesis has been observed. The risk factors for periprosthetic infection of tumor prosthesis remain unclear. This study examines the risk factors and outcomes of periprosthetic infection. This was a retrospective observational study including 121 patients (67 males and 54 females) who underwent tumor prosthesis of the lower limb after resection of musculoskeletal tumors between 1 January 2000 and 30 November 2018. Among a total of 121 tumor prostheses, 7 were total femurs, 47 were proximal femurs, 47 were distal femurs, and 20 were proximal tibias. The incidence of postoperative infection and its risk factors were analyzed. Forty-five patients (37%) had osteosarcoma, 36 patients (30%) had bone metastasis, and 10 patients (8%) had soft-tissue tumors invading the bone. The mean operating time was 229 min, and the mean follow-up duration was 5.9 years. Deep periprosthetic infection was noted in 14 patients (12%). In the multivariate analysis, the risk factors for postoperative infection were identified as being male (hazard ratio [HR], 11.2316; p = 0.0100), soft-tissue tumor (HR, 52.2443; p = 0.0003), long operation (HR, 1.0056; p = 0.0184), and radiotherapy (HR, 6.5683; p = 0.0476). The incidence of periprosthetic infection in our institution was similar to that of previous reports. Patients undergoing tumor prosthesis of the lower limb who were male, had a soft-tissue tumor, were predicted to have a long operation, and who underwent radiation, had an increased possibility of postoperative infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Fujiwara

Ebihara

Kitade

et al. 2020

JCM

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“…In our study group, revision surgeries were not performed. This was due to the fact that the study aimed to present the early treatment outcomes, while the number of complications increases with time that elapses since the surgery [12,14,20,21,22].…”

Section: Discussionmentioning

confidence: 99%

Resection arthroplasty of the knee – early treatment outcomes and rehabilitation efficiency

Pitera¹,

Guzik²,

Biega³

et al. 2019

Chir. Narzadow Ruchu Ortop. Pol.

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Introduction. Resection arthroplasty of the knee is frequently used in patients with bone tumours. Rehabilitation plays an important role in optimizing the functioning of the patients. The aim of this study was to asses treatment and physical performance outcomes after modular prosthesis surgery and to demonstrate rehabilitation methods. Material and methods. A total of 36 resections of the tumours localized in the knee joint region, followed by modular prosthetic replacement, were performed at the Orthopaedic Oncology Department in Brzozów between 2014-2016. Females accounted for 47% of the group. The mean age of the patients were 60 years (range: 36-78 years). All the patients were rehabilitated according to the own protocol. The physical performance was assessed using the MSTS. The intensity of pain was measured with the use of the VAS (Visual Analogue Scale). Results. 24 MUTARS and 12 GMRS prostheses were implanted. The implants were fixed with bone cement in 7 (20%) cases and cementless in 29 (80%) cases. Six weeks following surgery, the mean functional status was 21,6 points (72%), the mean pain intensity assessed with the VAS was 4,2 points and 19 (53%) patients could walk without aid of crutches and unassisted by others. Conclusions. Modular prosthesis implantation provides good functional results. The rehabilitation procedure presented in our study positively affects the functional outcome. Postoperative complications were scarce.

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The microbial profile of infected endoprosthetic reconstructions after wide excision for patients with musculoskeletal tumors: A call for pathogen‐based practices

Trikha,

Greig,

Sekimura

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesPeriprosthetic infection is a devastating complication following endoprosthetic reconstruction. This study utilized a large database of endoprostheses to describe the incidence, risk factors, and microbial profile of such infections to better catalogue and understand these catastrophic events.MethodsA retrospective review of endoprosthetic reconstructions for an oncologic indication from January 1, 1981 to December 31, 2020 was performed. Demographic, oncologic, procedural and outcome data was analyzed. Multivariable logistic regression was used to identify potential risk factors for infection with significance defined as p < 0.05.ResultsForty four out of 712 (6.2%) reconstructions resulted in infection at a mean time of 39.9 ± 44.5 months. Revision surgery (odds ratio [OR] 6.14, p < 0.001) or having a postoperative wound complication (OR 7.67, p < 0.001) were significantly associated with infection. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly cultured organisms at a rate of 34.1% (15/44) and 22.7% (10/44), respectively. Ten infections resulted in amputation; five due to antimicrobial‐resistant infections and three due to polymicrobial infections.ConclusionUnderstanding the microbial profile of patients undergoing endoprosthetic reconstruction is paramount. This study demonstrates a relatively high rate of polymicrobial and antibiotic‐resistant infections that portend worse outcomes, thus suggesting that pathogen‐specific infectious practices may be warranted.Level of EvidenceRetrospective cohort study, level III.

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Efficacy of different revision procedures for infected megaprostheses in musculoskeletal tumour surgery of the lower limb

Cited by 32 publications

References 33 publications

Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

Resection arthroplasty of the knee – early treatment outcomes and rehabilitation efficiency

The microbial profile of infected endoprosthetic reconstructions after wide excision for patients with musculoskeletal tumors: A call for pathogen‐based practices

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