Infection following Bone Tumor Resection and Reconstruction with Tumoral Prostheses: A Literature Review

Abstract

Bone resection is the choice treatment of malignant bone tumors. Tumor prosthesis is one of the most common solutions of reconstruction following resection of bone tumor located to the metaphysis of long bones. Periprosthetic infections are a frequent complication of limb-salvage surgery which is largely due to prolonged and repeated surgeries, as well as to the immunocompromised condition of these patients due to neoplastic treatment. Furthermore, the large exposure of tissues during this type of surgery and the dissection across vascular distributions also contributes to the high risk of infection. The authors reviewed the literature discussing the incidence of infections of tumor prosthesis implanted following resection of bone tumors, taking into account the different sites of implantation. In the English literature, the highest risk of infection which led to limb amputation was observed after proximal tibia resection and this difference was considered to be due to the poor condition of soft tissue and also after pelvic resection due to huge dead space after sarcoma resection not filled by implant. Independent of the location, the management of infected prosthesis is similar. That is, after one or more attempts at debridement and antibiotic therapy, it consists of implant removal and insertion of a new implant in a one-or two-stage procedure, with a decreased risk of failure with the two-stage procedure.Afterwidetumor resection,limb-salvageprocedures are considered the treatment of choice in 85-95% of cases (1), in comparison to the past when the surgical option was most frequently limb amputation. Limb reconstruction is usually obtained by tumor prostheses and the evolution of these implants has significantly modified clinical outcomes oflimb bone tumors.Currently, in many centres, limb salvage surgery and reconstruction with endoprosthesis is considered the standard procedure for treatment of malignant bone tumors located in metaphysis of long bones. This is due to the improvement in operative techniques, better patient selection and advances in prosthetic designs. Nowadays, the use of this procedure is markedly increased in the treatment of both aggressive benign and malignant musculoskeletal neoplasms. The advantages of prosthetic reconstruction include rapid functional restoration as well as good long-term functional outcome. The disadvantages include the risk of wear, aseptic loosening, fracture and peri-prosthetic infection (2-3).The implantation of a prosthesis presents several complications. One of the most feared is undoubtedly

Hip disarticulation – case series analysis and literature review

“…In the present sample, we observed that most disarticulations due to infection occurred in the context of patients with large tumor prostheses, which is in agreement with higher risk of these reconstructions to develop infection, not only due to the length and surgery duration, but also to the immunocompromised status of patients 12 . Predictably, complications after hip disarticulation are frequent, not only due to the extent of surgery, but also because patients often present extreme situations, with multiple comorbidities and hemodynamic instability.…”

Limb salvage surgery for osteosarcoma

“…This complication rate may increase with a longer followup. The rate of infection reported in most series limb salvage with endoprosthesis is around 10-15% while we had a proven deep infection in three (one with an endoprosthesis, two with biological reconstruction) (5.9%) patients 161819. A prompt management of complications is mandatory for a satisfactory outcome and only one of our patients had to have a secondary amputation for a nononcological indication.…”

Imaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors

“…According to some authors, complications occur in up to 85% of patients over a period of 5 years since implantation, including infections (4–12%), loosening of prosthesis (4–8%), fractures (1.6–4%) and local recurrence (4%) [9,10]. In our patients, only 32% had complications with a follow-up of up to 8 years.…”