Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

Abstract

Background The rate of postoperative infection developing is higher after limb salvage surgery (LSS) following sarcoma resection compared with conventional arthroplasty. The goal of this study is to summarize our experience in management of periprosthetic joint infection (PJI) and the risk factors of early PJI after LSS. Methods Between January 2010 and July 2019, 53 patients with osteosarcoma in the lower extremities who encountered periprosthetic infection after segmental tumor endoprosthetic replacement in our center were analyzed. Detailed patient characteristics and therapeutic information were collected from database of our institution or follow-up data and we divided patients according to the interval time between infection and tumor resection (surgery-infection interval) and investigate potential risk factors. Results A total of 53 (5.08%) patients were suffered postoperative infection. The average interval between surgery and clinical signs of deep infections are 27.5 days. For the drainage culture, positive results were only presented in 11 patients (20.8%). Almost half of this study’s (47.2%) patients underwent a traditional two-stage revision, that was, after the removal of the infected prosthesis, we applied antibiotic-loaded bone cements as a spacer. The mean blood loss during initial implantation surgery and operation time both correlated with interval period between PJI and initial implantation significantly (P = 0.028, P = 0.046). For several patients which infection marker was hardly back to normal after spacer implantation, we conservatively introduced an improved combination of bone cement and prosthesis for the second-stage surgery (5.6%). There were six patients needing re-operation, of which three were due to the aseptic loosening of the prosthesis, one developed periprosthetic infection again, and two patients encountered local recurrence and underwent amputation. Two patients were dead from distal metastasis. Conclusions A two-stage revision strategy remains effective and standardized methods for PJI patients. Total operation time and blood loss during LSS of osteosarcoma are the main risk factors of early PJI. For the patients without confirmed eradiation of microorganisms, an improved combination of bone cement and prosthesis applied in the second-stage surgery could achieve satisfied functional and oncologic results.

Cutaneous diphtheria complicated oncologic reconstruction surgery in osteosarcoma

“…17 Surgical site infections could be classified as early, delayed, and late based on the time interval between surgery F I G U R E 1 Inflamed, necrotic lesion on the anterior aspect of the right tibia and infection. The different treatment strategies may be considered according to the clinical manifestation, laboratory examination, and radiological findings described by Lin, T et al 4 The recommended treatment approaches for SSIs are systemic antibiotics, debridement, bone-cement spacer placement, two-stage prosthesis revision, bone transposition, combined implantation of cement and prosthesis, and partial or radical amputation after limb salvage surgery for patients with osteosarcoma. 4 Noninfectious complications such as non-union of allograft F I G U R E 2 Sagittal T 1 WI, T 2 WI, and fat-sat T 2 WI show low-signal T 1 WI and high heterogeneity signal T 2 WI of the right tibia proximal metaphysis extend and involve epiphysis associated with periosteal reaction and adjacent soft tissue signal changes.…”

“…1 The incidence rates range between 4.6 and 6.8/year/million in a different race, with a 5-year overall survival rate of about 54%-68%. 2,3 The surgical site infections (SSIs) usually occur 4 weeks after surgery 4 ; however, it may be delayed for about 5 months. 5 Chemotherapy, orthopedic surgical removal of the primary tumor (including limb-sparing excisions and partial or radical amputations), 6 with or without radiation therapy, is the standard treatment strategy for osteosarcoma.…”

Using 3D Printing Technology to Manufacture Personalized Bone Cement Placeholder Mold for Bone Defect Repair and Reconstruction with Infection: A Case Report

“…Patients often need to undergo multiple surgical treatments, and many patients will even have to undergo amputation due to uncontrolled infection. [ 7 , 8 , 9 ] Some literature suggests that materials for reconstruction of bone defects should be removed during infection treatment. [ 8 , 9 , 10 , 11 ] Others have proposed a two‐stage revision consisting of complete removal of the mega‐prosthesis or allograft, insertion of the antibiotic‐loaded bone cement spacer (ALCS), and implantation of a new mega‐prosthesis or new components.…”

“…[ 7 , 8 , 9 ] Some literature suggests that materials for reconstruction of bone defects should be removed during infection treatment. [ 8 , 9 , 10 , 11 ] Others have proposed a two‐stage revision consisting of complete removal of the mega‐prosthesis or allograft, insertion of the antibiotic‐loaded bone cement spacer (ALCS), and implantation of a new mega‐prosthesis or new components. [ 8 , 9 , 11 , 12 , 13 ] ALCS play an important role in the treatment of infection, but traditional ALCS needs to be handmade in surgery.…”

Collaborative Design of MgO/FeOx Nanosheets on Titanium: Combining Therapy with Regeneration

“…[4,5] Additionally, postoperative bacterial infections could easily occur due to the reduced immunity in cancer patients and the lack of antibacterial activity of Ti implant. [6] Furthermore, Ti is bioinert, which means a potential poor integration between the implant and the bone tissue and could easily lead to loosening. [7] Therefore, there is an urgent need to develop a multifunctional Ti implant that possesses good antitumor, antibacterial, and osteogenic properties, in other words, combining the therapy and regeneration function.…”