Endoprosthetic Reconstruction in 250 Patients with Sarcoma

Abstract

Therapeutic study, Level IV (case series).

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

“…It was decided to compare the prospectively collected data for the silver group with retrospectively collected data for the titanium group, since a prospective and randomized study would take more than 10 years even in a center specializing in bone sarcomas. Although the follow-up period is short, we believe it is possible for initial conclusions to be drawn, as most periprosthetic infections occur within the first 2 years postoperatively (81% in the present study) [2]. Both the titanium group and the silver group were relatively homogeneous with regard to the patients' characteristics.…”

“…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.…”

“…Patients with proximal tibia and femur replacements were chosen because the infection rates were highest at these sites in our institution [2]. Further studies with more patients, longer follow-up periods, and with all replacement sites of will of course have to follow.…”

“…The overall 5-year survival rate for endoprostheses increased from 20% to 85% during this period-a significant increase that is particularly important in view of the increased patient survival rates and the increasingly frequent implantation of endoprostheses in young and physically active patients [1]. However, the placement of endoprostheses as a limb-saving treatment is accompanied by a high rate of late complications such as loosening, mechanical failure, and periprosthetic infection, despite the routine use of antibiotic prophylaxis [1,2]. Capanna et al [3] recorded an infection rate of 43% after revision surgery for tumor endoprostheses.…”

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%.…”