Skip to main content
Erschienen in: Archives of Orthopaedic and Trauma Surgery 2/2017

25.10.2016 | Orthopaedic Surgery

Lower limb reconstruction in tumor patients using modular silver-coated megaprostheses with regard to perimegaprosthetic joint infection: a case series, including 100 patients and review of the literature

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose and objective

Bone resection regarding adequate surgical margins is the treatment of choice for malignant bone tumors. In the case of metastasis-related complications, so-called skeletal-related events, it is highly important to achieve pain relief and a stable joint situation to re-mobilize the patients immediately following surgery. To bridge the often large osseous defect zones after tumor resection, both cemented and uncemented modular endoprosthetic systems are widely used. Patients undergoing tumor-related endoprosthetic orthopedic surgery are facing high risk for developing a periprosthetic joint infection (PJI). The immunocompromised condition due to anti-neoplastic treatment and long operation time with large exposure of tissue contributes to a high risk of infection.

Methods

The authors present a case series of 100 patients (31% primary bone tumor and 69% metastasis-related surgery) undergoing tumor-related lower limb salvage surgery with special regard to periprosthetic joint infection and the management of this “difficult to treat” situation. Furthermore, a review of the current literature regarding infection following bone tumor resection and endoprosthetic reconstruction is performed and discussed.

Results

The median follow-up was 24 months (range 12–108 months). Ten patients (10%) suffered from a periprosthetic joint infection. We recorded six acute infections (type I) <4 weeks after surgery, one infection >4 weeks after surgery (type II), and three late infections (type III). According to the definition of Laffer et al., three of our patients (30%) are probably free of infection, one patient died of PJI-associated sepsis, and five patients were free of infection, but without restoration of the affected joint.

Conclusion

In conclusion, our own results show that perimegaprosthetic joint infection among silver-coated implants, in patients undergoing tumor-related surgery of the lower limb, is lower compared to non-silver-coated implants. Due to heterogeneity of patients and potential treatment options, the treatment regime should be tailored for the patients’ individual situation.
Literatur
2.
Zurück zum Zitat Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C (2010) Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol 23(4):1005–1013CrossRefPubMed Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C (2010) Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol 23(4):1005–1013CrossRefPubMed
5.
Zurück zum Zitat Eckardt JJ, Eilber FR, Rosen G, Mirra JM, Dorey FJ, Ward WG, Kabo JM (1991) Endoprosthetic replacement for stage IIB osteosarcoma. Clin Orthop Relat Res 270:202–213 Eckardt JJ, Eilber FR, Rosen G, Mirra JM, Dorey FJ, Ward WG, Kabo JM (1991) Endoprosthetic replacement for stage IIB osteosarcoma. Clin Orthop Relat Res 270:202–213
9.
Zurück zum Zitat Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Jt Surg Am 93(5):418–429. doi:10.2106/JBJS.J.00834 CrossRef Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Jt Surg Am 93(5):418–429. doi:10.​2106/​JBJS.​J.​00834 CrossRef
10.
Zurück zum Zitat Holzer G, Windhager R, Kotz R (1997) One-stage revision surgery for infected megaprostheses. J Bone J Surg Br 79(1):31–35CrossRef Holzer G, Windhager R, Kotz R (1997) One-stage revision surgery for infected megaprostheses. J Bone J Surg Br 79(1):31–35CrossRef
11.
Zurück zum Zitat Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A (2008) Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Jt Surg Am 90(6):1265–1271. doi:10.2106/JBJS.F.01324 CrossRef Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A (2008) Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Jt Surg Am 90(6):1265–1271. doi:10.​2106/​JBJS.​F.​01324 CrossRef
12.
Zurück zum Zitat Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, Takeda K, Kikuta K, Hosaka S, Yazawa Y, Takeuchi K, Anazawa U, Mochizuki K, Satomi K (2010) Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci Off J Jpn Orthop Assoc 15(3):331–339. doi:10.1007/s00776-010-1467-z Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, Takeda K, Kikuta K, Hosaka S, Yazawa Y, Takeuchi K, Anazawa U, Mochizuki K, Satomi K (2010) Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci Off J Jpn Orthop Assoc 15(3):331–339. doi:10.​1007/​s00776-010-1467-z
13.
Zurück zum Zitat Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT (1991) Prosthetic replacement of the distal femur for primary bone tumours. J Bone Jt Surg Br 73(5):762–769 Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT (1991) Prosthetic replacement of the distal femur for primary bone tumours. J Bone Jt Surg Br 73(5):762–769
14.
Zurück zum Zitat Wirganowicz PZ, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM (1999) Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res 358:64–74CrossRef Wirganowicz PZ, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM (1999) Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res 358:64–74CrossRef
15.
Zurück zum Zitat Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M (1994) Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Jt Surg Br 76(2):178–186 Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M (1994) Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Jt Surg Br 76(2):178–186
16.
Zurück zum Zitat Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR (2000) Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 73(4):198–205CrossRefPubMed Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR (2000) Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 73(4):198–205CrossRefPubMed
17.
Zurück zum Zitat McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 403:8–15CrossRef McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 403:8–15CrossRef
18.
Zurück zum Zitat Jacofsky DJ, Haidukewych GJ, Zhang H, Sim FH (2004) Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop Relat Res 427:52–56CrossRef Jacofsky DJ, Haidukewych GJ, Zhang H, Sim FH (2004) Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop Relat Res 427:52–56CrossRef
20.
Zurück zum Zitat Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res 442:223–229CrossRefPubMed Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res 442:223–229CrossRefPubMed
22.
Zurück zum Zitat Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM (2002) Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res 400:225–235CrossRef Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM (2002) Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res 400:225–235CrossRef
24.
Zurück zum Zitat Aljassir F, Beadel GP, Turcotte RE, Griffin AM, Bell RS, Wunder JS, Isler MH (2005) Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis. Clin Orthop Relat Res 438:36–41CrossRefPubMed Aljassir F, Beadel GP, Turcotte RE, Griffin AM, Bell RS, Wunder JS, Isler MH (2005) Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis. Clin Orthop Relat Res 438:36–41CrossRefPubMed
25.
Zurück zum Zitat Wittig JC, Bickels J, Priebat D, Jelinek J, Kellar-Graney K, Shmookler B, Malawer MM (2002) Osteosarcoma: a multidisciplinary approach to diagnosis and treatment. Am Fam Physician 65(6):1123–1132PubMed Wittig JC, Bickels J, Priebat D, Jelinek J, Kellar-Graney K, Shmookler B, Malawer MM (2002) Osteosarcoma: a multidisciplinary approach to diagnosis and treatment. Am Fam Physician 65(6):1123–1132PubMed
26.
Zurück zum Zitat Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of A (2013) Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 56(1):1–10. doi:10.1093/cid/cis966 CrossRef Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of A (2013) Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 56(1):1–10. doi:10.​1093/​cid/​cis966 CrossRef
27.
Zurück zum Zitat Patel R, Osmon DR, Hanssen AD (2005) The diagnosis of prosthetic joint infection: current techniques and emerging technologies. Clin Orthop Relat Res 437:55–58CrossRef Patel R, Osmon DR, Hanssen AD (2005) The diagnosis of prosthetic joint infection: current techniques and emerging technologies. Clin Orthop Relat Res 437:55–58CrossRef
28.
Zurück zum Zitat Laffer RR, Graber P, Ochsner PE, Zimmerli W (2006) Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect Off Publ Euro Soc Clin Microbiol Infect Dis 12(5):433–439. doi:10.1111/j.1469-0691.2006.01378.x Laffer RR, Graber P, Ochsner PE, Zimmerli W (2006) Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect Off Publ Euro Soc Clin Microbiol Infect Dis 12(5):433–439. doi:10.​1111/​j.​1469-0691.​2006.​01378.​x
30.
Zurück zum Zitat Donati D, Biscaglia R (1998) The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours. J Bone Jt Surg Br 80(6):1045–1050CrossRef Donati D, Biscaglia R (1998) The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours. J Bone Jt Surg Br 80(6):1045–1050CrossRef
31.
Zurück zum Zitat Donati D, D’Arenzo R, Ercolani C, Boriani S (1995) Infection in limb salvage surgery for bone tumors. Euro J Orthop Surg Traumatol Orthop Traumatol 5(1):71–74. doi:10.1007/BF02716222 CrossRef Donati D, D’Arenzo R, Ercolani C, Boriani S (1995) Infection in limb salvage surgery for bone tumors. Euro J Orthop Surg Traumatol Orthop Traumatol 5(1):71–74. doi:10.​1007/​BF02716222 CrossRef
32.
Zurück zum Zitat Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM (2002) Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res 395:193–203CrossRef Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM (2002) Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res 395:193–203CrossRef
33.
Zurück zum Zitat Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibia. J Bone Jt Surg Br 81(3):488–494CrossRef Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibia. J Bone Jt Surg Br 81(3):488–494CrossRef
34.
Zurück zum Zitat Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126(5):289–296. doi:10.1007/s00402-005-0009-1 CrossRefPubMed Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126(5):289–296. doi:10.​1007/​s00402-005-0009-1 CrossRefPubMed
35.
Zurück zum Zitat Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, Hauschild G, Ahrens H (2010) Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 101(5):389–395. doi:10.1002/jso.21498 PubMed Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, Hauschild G, Ahrens H (2010) Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 101(5):389–395. doi:10.​1002/​jso.​21498 PubMed
36.
Zurück zum Zitat Kuhne CA, Taeger G, Nast-Kolb D, Ruchholtz S (2003) Knee arthrodesis after infected tumor mega prosthesis of the knee using an intramedullary nail for callus distraction. Langenbeck’s Arch Surg Dtsch Ges Fur Chir 388(1):56–59. doi:10.1007/s00423-003-0360-z Kuhne CA, Taeger G, Nast-Kolb D, Ruchholtz S (2003) Knee arthrodesis after infected tumor mega prosthesis of the knee using an intramedullary nail for callus distraction. Langenbeck’s Arch Surg Dtsch Ges Fur Chir 388(1):56–59. doi:10.​1007/​s00423-003-0360-z
37.
Zurück zum Zitat Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177CrossRef Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177CrossRef
38.
Zurück zum Zitat Jeys L, Grimer R (2009) The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res Fortschr Der Krebsforsch Progres Dans Les Rech Sur Le Cancer 179:75–84 Jeys L, Grimer R (2009) The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res Fortschr Der Krebsforsch Progres Dans Les Rech Sur Le Cancer 179:75–84
39.
Zurück zum Zitat Piccioli A, Donati F, Giacomo GD, Ziranu A, Careri S, Spinelli MS, Giannini S, Giannicola G, Perisano C, Maccauro G (2016) Infective complications in tumour endoprostheses implanted after pathological fracture of the limbs. Injury. doi:10.1016/j.injury.2016.07.054 Piccioli A, Donati F, Giacomo GD, Ziranu A, Careri S, Spinelli MS, Giannini S, Giannicola G, Perisano C, Maccauro G (2016) Infective complications in tumour endoprostheses implanted after pathological fracture of the limbs. Injury. doi:10.​1016/​j.​injury.​2016.​07.​054
40.
Zurück zum Zitat Donati F, Di Giacomo G, Ziranu A, Spinelli S, Perisano C, Rosa MA, Maccauro G (2015) Silver coated prosthesis in oncological limb salvage surgery reduce the infection rate. J Biol Regul Homeost Agents 29(4 Suppl):149–155PubMed Donati F, Di Giacomo G, Ziranu A, Spinelli S, Perisano C, Rosa MA, Maccauro G (2015) Silver coated prosthesis in oncological limb salvage surgery reduce the infection rate. J Biol Regul Homeost Agents 29(4 Suppl):149–155PubMed
41.
Metadaten
Titel
Lower limb reconstruction in tumor patients using modular silver-coated megaprostheses with regard to perimegaprosthetic joint infection: a case series, including 100 patients and review of the literature
Publikationsdatum
25.10.2016
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 2/2017
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2584-8

Weitere Artikel der Ausgabe 2/2017

Archives of Orthopaedic and Trauma Surgery 2/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.