Endoprosthetic Reconstruction for the Treatment of Musculoskeletal Tumors of the Appendicular Skeleton and Pelvis

Abstract

We believe these medium to long-term results with first-generation endoprostheses are encouraging and justify the continued use of endoprostheses for reconstruction following the excision of a bone tumor.

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

“…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). In the literature, overall infection rates of between 8.7% and 14% have been reported, with lower rates in the upper extremity and higher rates in the lower extremity [2,7,[16][17][18][19]. Patients with proximal tibia replacements in particular are at high risk for periprosthetic infection.…”

Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

“…Nevertheless, similar indications and contraindications were used for surgical planning in both institutions, and criteria for failure assessed with similar intent, despite the differences inherent in implant design. In a large study by Jeys et al [13], including 228 distal femoral EPRs, aseptic loosening accounted for 13.6% of all failures with a median time to revision due to mechanical failure of 9.3 years. Moreover, Mittermayer et al [20] and Unwin et al [27] found, at 10 years postoperatively, 24% and 32.6%, respectively, of patients who had distal femoral EPR underwent revision for aseptic loosening.…”

Management of infection following reconstruction in bone tumors

“…37 The rate of infections varies according to the site of replacement with lower rates in upper extremities and higher rates in lower extremities. [39][40][41][42][43][44] However postsurgical infection is more common in pelvic tumor surgeries. Several authors have reported infection rates ranging from 12% to 47%.…”

“…Late prosthetic infections are associated with poor results when treated by lavage, debridement, and prolonged antibiotics administration 67 ; therefore, removal of infected prosthesis either as 1-or 2-stage procedure or an amputation becomes necessary. 42,[68][69][70][71] The reported success rate of eradicating infection with amputation ranges from 98% to 100%, 72% to 91% with 2-stage revision, and 42% with 1-stage revision. 70 However Allison et al 36 reported success rate of 42% with irrigation and debridement procedures alone (without any component exchange), 70% with single-stage irrigation and debridement procedure with the addition of modular component exchange and varying degrees of suppressive antibiotics, and in contrast to other studies formal two-staged implant removal, antibiotic spacer placement with subsequent reimplantation was associated with 62%.…”