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Published in: Archives of Orthopaedic and Trauma Surgery 5/2006

01-07-2006 | Original Article

Characteristics and outcome of infections associated with tumor endoprostheses

Authors: J. Hardes, C. Gebert, A. Schwappach, H. Ahrens, A. Streitburger, W. Winkelmann, G. Gosheger

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2006

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Abstract

Introduction: Infection associated with prosthesis used after tumor resection is a common and serious complication. The purpose of the current retrospective study was to describe the course of infection in patients with a tumor endoprosthesis and the determination of risk factors associated with failed limb salvage. Material and Methods: 30 patients with an infection associated with a tumor endoprosthesis were investigated with regard to treatment strategies, number and type of revision operations, duration of hospital stay, determination of risk factors associated with failed limb salvage and final outcome. Results: Limb salvage related to the complication infection was achieved in 19 patients (63.3%). Two-stage reimplantation of an endoprosthesis was successful in 14 patients but subsequently failed in one patient. Out of 11 patients where limb salvage failed, an amputation was performed in 6 patients, a rotationplasty in 4, and stump lengthening procedure in 1 patient. A poor soft tissue condition was a significant (P<0.05) risk factor for failed limb salvage. No patient receiving chemotherapy with a poor soft tissue condition had limb salvage surgery. The mean number of revision operations per patients was 2.6. The mean duration of hospital stay was 68 days. Conclusion: Infection associated with prosthesis is a serious complication and is involved with long hospitalization. Limb salvage failed mostly in the case of a poor soft tissue condition. In these cases repeated revision surgery should be avoided and ablative surgery recommended at an early stage. Rotationplasty is an alternative to amputation in the case of an infection of the proximal or distal part of the femur.
Literature
1.
go back to reference Asavamongkolkul A, Eckardt JJ, Eilber F, Dorey FJ, Ward WG, Kelly CM, Wirganowitz PZ, Kabo JM (1999) Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop 360:207–220PubMedCrossRef Asavamongkolkul A, Eckardt JJ, Eilber F, Dorey FJ, Ward WG, Kelly CM, Wirganowitz PZ, Kabo JM (1999) Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop 360:207–220PubMedCrossRef
2.
go back to reference Bickels J, Meller I, Henshaw RM, Malawer MM (2000) Reconstruction of hip stability after proximal and total femur resections. Clin Orthop 375:218–230PubMedCrossRef Bickels J, Meller I, Henshaw RM, Malawer MM (2000) Reconstruction of hip stability after proximal and total femur resections. Clin Orthop 375:218–230PubMedCrossRef
3.
go back to reference Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KI, Meller I, Malawer MM (2002) Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop 400:225–235PubMedCrossRef Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KI, Meller I, Malawer MM (2002) Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop 400:225–235PubMedCrossRef
4.
go back to reference Bielack S, Kempf-Bielack B, Schwenzer D, Birkfellner T, Delling G, Ewerbeck V et al (1999) Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the cooperative osteosarcoma study group COSS of 925 patients. Klin Padiatr 211:260–70PubMed Bielack S, Kempf-Bielack B, Schwenzer D, Birkfellner T, Delling G, Ewerbeck V et al (1999) Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the cooperative osteosarcoma study group COSS of 925 patients. Klin Padiatr 211:260–70PubMed
5.
go back to reference Brigman BE, Kumagai SG, McGuire MH (2003) Rotationplasty after failed limb-sparing tumor surgery: a report of two cases. Clin Orthop 415:254–260PubMedCrossRef Brigman BE, Kumagai SG, McGuire MH (2003) Rotationplasty after failed limb-sparing tumor surgery: a report of two cases. Clin Orthop 415:254–260PubMedCrossRef
6.
go back to reference 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 Joint Surg Br 76:178–186PubMed 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 Joint Surg Br 76:178–186PubMed
7.
go back to reference Cunha-Gomes D, Manglani HH, Bhathena H, Badhwar R, Kavarana NM (1999) Gastrocnemius muscle transfer in limb-sparing surgery for bone tumors around the knee. Acta Chir Plast 41:3–6PubMed Cunha-Gomes D, Manglani HH, Bhathena H, Badhwar R, Kavarana NM (1999) Gastrocnemius muscle transfer in limb-sparing surgery for bone tumors around the knee. Acta Chir Plast 41:3–6PubMed
8.
go back to reference Eckardt JJ, Lesavoy MA, Dubrow TJ, Wackym PA (1990) Exposed endoprosthesis. Management protocol using muscle and myocutaneous flap coverage. Clin Orthop 251:220–229PubMed Eckardt JJ, Lesavoy MA, Dubrow TJ, Wackym PA (1990) Exposed endoprosthesis. Management protocol using muscle and myocutaneous flap coverage. Clin Orthop 251:220–229PubMed
9.
go back to reference Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM (2002) Two-stage revison for infected endoprostheses used in tumor surgery. Clin Orthop 395:193–203PubMedCrossRef Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM (2002) Two-stage revison for infected endoprostheses used in tumor surgery. Clin Orthop 395:193–203PubMedCrossRef
10.
go back to reference Gosheger G, Hillmann A, Rodl R, Ozaki T, Gebert C, Winkelmann W (2001) Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients. Acta Orthop Scand 72:533–536PubMedCrossRef Gosheger G, Hillmann A, Rodl R, Ozaki T, Gebert C, Winkelmann W (2001) Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients. Acta Orthop Scand 72:533–536PubMedCrossRef
11.
go back to reference Gosheger G, Hardes J, Ahrens H, Streitbuerger A, Buerger H, Erren M, Gunsel A, Kemper FH, Winkelmann W, von Eiff Ch (2004) Silver-coated megaendoprostheses in a rabbit model—an analysis of the infection rate and toxicological side-effects. Biomaterials 25: 5547–5556PubMedCrossRef Gosheger G, Hardes J, Ahrens H, Streitbuerger A, Buerger H, Erren M, Gunsel A, Kemper FH, Winkelmann W, von Eiff Ch (2004) Silver-coated megaendoprostheses in a rabbit model—an analysis of the infection rate and toxicological side-effects. Biomaterials 25: 5547–5556PubMedCrossRef
12.
go back to reference Ham SJ, Schraffordt Koops H, Veth RP, van Horn JR, Molenaar WM, Hoekstra HJ (1998) Limb salvage surgery for primary bone sarcoma of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol 5:423–436PubMedCrossRef Ham SJ, Schraffordt Koops H, Veth RP, van Horn JR, Molenaar WM, Hoekstra HJ (1998) Limb salvage surgery for primary bone sarcoma of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol 5:423–436PubMedCrossRef
13.
14.
go back to reference Hillmann A, Gosheger G, Hoffmann C, Ozaki T (2000) Rotationplasty—surgical treatment after failed limb salvage procedure. Arch Orthop Trauma Surg 120:555–558PubMedCrossRef Hillmann A, Gosheger G, Hoffmann C, Ozaki T (2000) Rotationplasty—surgical treatment after failed limb salvage procedure. Arch Orthop Trauma Surg 120:555–558PubMedCrossRef
15.
go back to reference Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstruction last? Clin Orthop 293:280–286PubMed Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstruction last? Clin Orthop 293:280–286PubMed
16.
go back to reference Ilyas I, Kurar A, Moreau PG, Younge DA (2001) Modular megaprosthesis for distal femoral tumors. Int Orthop 25:375–377PubMedCrossRef Ilyas I, Kurar A, Moreau PG, Younge DA (2001) Modular megaprosthesis for distal femoral tumors. Int Orthop 25:375–377PubMedCrossRef
17.
go back to reference Jeys LM, Grimer RJ, Carter SR, Tillman RM (2003) Risk of amputation following limb salvage surgery with endoprosthetic replacement in a consecutive series of 1261 patients. Int Orthop 27:160–163PubMed Jeys LM, Grimer RJ, Carter SR, Tillman RM (2003) Risk of amputation following limb salvage surgery with endoprosthetic replacement in a consecutive series of 1261 patients. Int Orthop 27:160–163PubMed
18.
go back to reference Kotz R, Ritschl P, Trachtenbrodt J (1986) A modular femur-tibia reconstruction system. Orthopedics 9:1639–1652PubMed Kotz R, Ritschl P, Trachtenbrodt J (1986) A modular femur-tibia reconstruction system. Orthopedics 9:1639–1652PubMed
19.
go back to reference 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. Langenbecks Arch Surg 388:56–59PubMed 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. Langenbecks Arch Surg 388:56–59PubMed
20.
go back to reference Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM (2003) Endoprosthetic replacement of the proximal humerus. Long-term results. J Bone Joint Surg Br 85:717–722PubMed Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM (2003) Endoprosthetic replacement of the proximal humerus. Long-term results. J Bone Joint Surg Br 85:717–722PubMed
21.
go back to reference Leggon RE, Huber TS, Scarborough MT (2001) Limb salvage surgery with vascular reconstruction. Clin Orthop 387:207–216PubMedCrossRef Leggon RE, Huber TS, Scarborough MT (2001) Limb salvage surgery with vascular reconstruction. Clin Orthop 387:207–216PubMedCrossRef
22.
go back to reference Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 77:1154–1165PubMed Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 77:1154–1165PubMed
23.
go back to reference 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 388:167–177PubMedCrossRef 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 388:167–177PubMedCrossRef
24.
go back to reference Nebelung W, Birger T, Ropke M, Neumann HW (2000) Rotationplasty as a salvage procedure in revision of tumor endoprosthesis of the distal femur—a report of two cases. Arch Orthop Trauma Surg 120:541–543PubMedCrossRef Nebelung W, Birger T, Ropke M, Neumann HW (2000) Rotationplasty as a salvage procedure in revision of tumor endoprosthesis of the distal femur—a report of two cases. Arch Orthop Trauma Surg 120:541–543PubMedCrossRef
25.
go back to reference Paulussen M, Frohlich B, Jurgens H (2001) Ewing tumour: incidence, prognosis and treatment options. Paediatr Drugs 3:899–913PubMedCrossRef Paulussen M, Frohlich B, Jurgens H (2001) Ewing tumour: incidence, prognosis and treatment options. Paediatr Drugs 3:899–913PubMedCrossRef
26.
go back to reference Plotz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R (2002) Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop 405:207–215PubMedCrossRef Plotz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R (2002) Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop 405:207–215PubMedCrossRef
27.
go back to reference Ritschl P, Capanna R, Helwig U, Campanacci M, Kotz R (1992) KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity. Z Orthop Ihre Grenzgeb 130:290–293PubMedCrossRef Ritschl P, Capanna R, Helwig U, Campanacci M, Kotz R (1992) KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity. Z Orthop Ihre Grenzgeb 130:290–293PubMedCrossRef
28.
go back to reference Shin DS, Weber KL, Chao EY, An KN, Sim FH (1999) Reoperation for failed prosthetic replacement used for limb salvage. Clin Orthop 358:53–63PubMed Shin DS, Weber KL, Chao EY, An KN, Sim FH (1999) Reoperation for failed prosthetic replacement used for limb salvage. Clin Orthop 358:53–63PubMed
29.
go back to reference Tomita K, Tsuchiya H (1989) Intermediate results and functional evaluation of limb-salvage surgery for osteosarcoma: an intergroup study in Japan. J Surg Oncol 41:71–76PubMedCrossRef Tomita K, Tsuchiya H (1989) Intermediate results and functional evaluation of limb-salvage surgery for osteosarcoma: an intergroup study in Japan. J Surg Oncol 41:71–76PubMedCrossRef
30.
go back to reference Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R (2004) Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 117:556–562PubMedCrossRef Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R (2004) Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 117:556–562PubMedCrossRef
31.
go back to reference Wicart P, Mascard E, Missenard G, Dubousset J (2002) Rotationplasty after failure of a knee prosthesis for a malignant tumor of the distal femur. J Bone Joint Surg Br 84:865–869PubMedCrossRef Wicart P, Mascard E, Missenard G, Dubousset J (2002) Rotationplasty after failure of a knee prosthesis for a malignant tumor of the distal femur. J Bone Joint Surg Br 84:865–869PubMedCrossRef
32.
go back to reference Wirganowicz PC, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM (1999) Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop 358:64–74PubMed Wirganowicz PC, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM (1999) Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop 358:64–74PubMed
Metadata
Title
Characteristics and outcome of infections associated with tumor endoprostheses
Authors
J. Hardes
C. Gebert
A. Schwappach
H. Ahrens
A. Streitburger
W. Winkelmann
G. Gosheger
Publication date
01-07-2006
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 5/2006
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-005-0009-1

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