Periprosthetic Infection in Patients Treated for an Orthopaedic Oncological Condition

Abstract

Patients treated with an orthopaedic procedure for an oncological condition have high infection rates. The treatment of infection in these patients is arduous and lengthy, with a substantial risk of amputation.

Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors

“…These secondary complications occurred over time, and while revision surgery can be successful in many, some patients experienced further complications and implant failure, an observation noted by others [4,6,13,20,21,24]. Clearly, further efforts in understanding the causes of complications and strategies to prevent them could lead to substantial improvements in implant survival.…”

“…While others have reported specifically on these complications and potential methods of salvage following complications of endoprosthetic reconstruction [6,12,13,20,21,23,24], little has been published regarding the incidence of complications seen with extended followup or how patients fared longitudinally after undergoing salvage of a complication. Some of these studies concentrated only on infection [6,12,13] while others reviewed the major types of complications without discussing their time frame, concentrating on survivor analysis rather on complications analysis [1,8,11,14,21,23,24]. We previously reported early results of a cohort of 82 patients who underwent segmental endoprosthetic replacement for sarcoma of bone, which showed a prosthetic survival rate of 83% at 5 years and 67% at 10 years [17].…”

Der proximale und komplette Femurersatz

“…Hervorzuheben sind insbesondere die aseptische Lockerung, der tiefe Protheseninfekt und die Luxation [15,20,22]. Die Prothesenluxation rückt anscheinend durch die Verwendung bipolarer Köpfe (Duokopf) bei der hemiprothetischen Versorgung oder durch Implantation tripolarer Pfannensysteme bei der Totalprothese in den Hintergrund.…”

“…Das Erregerspektrum umfasst neben den am häufigsten nachgewiesenen Staphylokokken zunehmend multiresistente Subspezies wie MRSA oder MRSE [18]. Risikofaktoren für das Auftreten einer periprothetischen Infektion sind lange Operationszeiten, ausgedehnte Resektionen mit schlechter Weichteildeckung der Endoprothese, reduzierte Immunabwehr durch adjuvante Radio-/ Chemotherapie sowie die onkologische Grunderkrankung selbst [3,20,25]. Die antibakterielle Wirkung silberbeschichteter Oberflächen modularer Tumorendoprothesen kann das Infektionsrisiko senken [15,16].…”

Knee salvage in revision arthroplasty after massive bone loss of the femur condyles (≥Engh III) with a single-modular-hinged knee revision implant

“…However, the reinfection rate after implanting megaendoprostheses after two-stage treatment of implantinfections was not mentioned in their study. It is also noteworthy that infection rates of up to 20 % are reported in primary reconstruction after tumor resection [18][19][20][21]. Direct comparison of our study population with that of patients treated for oncological conditions does not apply though, as these patients often receive intensive chemotherapy or local irradiation affecting the infection rate negatively.…”