The Long-Term Risks of Infection and Amputation with Limb Salvage Surgery Using Endoprostheses

Jeys, Lee; Grimer, R. J.

doi:10.1007/978-3-540-77960-5_7

Cited by 73 publications

(60 citation statements)

References 37 publications

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“…However, in a study by Jeys et al it was observed that in infected patients, the time period without metastases was longer but this was not significant. The postulated mechanisms for increased survival included stimulation of tumor necrosis factor (TNF)-a, cytotoxic cell-mediated tumor suppression and prevention of tumor neovascularization (35).…”

Section: Discussionmentioning

confidence: 99%

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

Graci¹,

Maccauro²,

Muratori

et al. 2010

Int J Immunopathol Pharmacol

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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

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Section: Discussionmentioning

confidence: 99%

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

Graci¹,

Maccauro²,

Muratori

et al. 2010

Int J Immunopathol Pharmacol

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“…Biofilms also trigger inflammation and impair the wound-healing process (44). Frequently, the only effective treatment option for biofilm-based chronic wound infections is to amputate the infected limb (21).…”

mentioning

confidence: 99%

Identification of a Novel Benzimidazole That Inhibits Bacterial Biofilm Formation in a Broad-Spectrum Manner

Sambanthamoorthy

Gokhale

Lao

et al. 2011

Antimicrob Agents Chemother

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Bacterial biofilm formation causes significant industrial economic loss and high morbidity and mortality in medical settings. Biofilms are defined as multicellular communities of bacteria encased in a matrix of protective extracellular polymers. Because biofilms have a high tolerance for treatment with antimicrobials, protect bacteria from immune defense, and resist clearance with standard sanitation protocols, it is critical to develop new approaches to prevent biofilm formation. Here, a novel benzimidazole molecule, named antibiofilm compound 1 (ABC-1), identified in a small-molecule screen, was found to prevent bacterial biofilm formation in multiple Gram-negative and Gram-positive bacterial pathogens, including Pseudomonas aeruginosa and Staphylococcus aureus, on a variety of different surface types. Importantly, ABC-1 itself does not inhibit the growth of bacteria, and it is effective at nanomolar concentrations. Also, coating a polystyrene surface with ABC-1 reduces biofilm formation. These data suggest ABC-1 is a new chemical scaffold for the development of antibiofilm compounds.

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“…Infection can further delay adjuvant therapy. In approximately 20% of cases, deep infection ultimately results in limb salvage failure or amputation [32]. The risk of infection also can vary dramatically with tumor site.…”

Section: Introductionmentioning

confidence: 99%

“…Limb salvage surgery (LSS) by means of tumor resection and reconstruction has become the standard of care in the treatment of long-bone sarcomas, resulting in limb salvage rates greater than 90% [32]. Endoprostheses provide several advantages over other reconstructive methods.…”

Section: Introductionmentioning

confidence: 99%

High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review

Racano

Pazionis

Farrokhyar

et al. 2013

Clinical Orthopaedics &Amp; Related Research

116

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Background Limb salvage surgery (LSS) with endoprosthetic replacement is the most common method of reconstruction following bone tumor resection in the adult population. The risk of a postoperative infection developing is high when compared with conventional arthroplasty and there are no appropriate guidelines for antibiotic prophylaxis. Questions/purposes We sought to answer the following questions: (1) What is the overall risk of deep infection and the causative organism in lower-extremity long-bone tumor surgery with endoprosthetic reconstruction? (2) What antibiotic regimens are used with endoprosthetic reconstruction? (3) Is there a correlation between infection and either duration of postoperative antibiotics or sample size? Methods We conducted a systematic review of the literature for clinical studies that reported infection rates in adults with primary bony malignancies of the lower extremity treated with surgery and endoprosthetic reconstruction. The search included articles published in English between 1980 and July 2011. Results The systematic literature review yielded 48 studies reporting on a total of 4838 patients. The overall pooled weighted infection rate for lower-extremity LSS with endoprosthetic reconstruction was approximately 10% (95% CI, 8%-11%), with the most common causative organism reported to be Gram-positive bacteria in the majority of cases. The pooled weighted infection rate was 13% after short-term postoperative antibiotics and 8% after long-term postoperative antibiotics. There was no correlation between sample size and infection rate. Conclusions Infection rates of 10% are high when compared with rates for conventional arthroplasty. Our results suggest that long-term antibiotic prophylaxis decreases the risk of deep infection. However, the data should be interpreted with caution owing to the retrospective nature of the studies.

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The Long-Term Risks of Infection and Amputation with Limb Salvage Surgery Using Endoprostheses

Cited by 73 publications

References 37 publications

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

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

Identification of a Novel Benzimidazole That Inhibits Bacterial Biofilm Formation in a Broad-Spectrum Manner

High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review

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