Fighting Megaprosthetic Infections: What are the Chances of Winning?

Gundavda, Manit K.; Katariya, Ameya; Reddy, Rajeev; Agarwal, Manish

doi:10.1007/s43465-020-00080-z

Cited by 8 publications

(9 citation statements)

References 45 publications

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“…It is therefore critical to formulate suitable treatment strategies in consultation with a multidisciplinary team for combined surgical and medical management. Currently, two-stage revision with complete removal of the endoprosthesis is the primary treatment for these patients [25][26][27]. In our study, more than half of all patients received two-stage revision, among which three patients were treated with combined prosthetic revision and implantation with cement at the second stage of the revision (Fig.…”

Section: Discussionmentioning

confidence: 75%

“…In the case presented, the patient was able to walk unaided 4 months after the second-stage procedure, and his MSTS score was 22 at the last follow-up. Gundavda et al [ 26 ] demonstrated that the mean MSTS score of patients with PJI after initial implantation of a mega-prosthesis can reach 23.5 with a traditional two-stage revision. In our study, the mean MSTS score of all patients was 20 (range 17–23), and the three patients who received the improved revision strategy had scores of 20, 22, and 23, respectively, which is similar to or better than when a conventional two-stage revision is performed.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with a PJI, the re-infection rate is increased dramatically, and successful local infection control is critical for these patients [24][25][26][27]. It is therefore critical to formulate suitable treatment strategies in consultation with a multidisciplinary team for combined surgical and medical management.…”

Section: Discussionmentioning

confidence: 99%

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Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

Lin

Jin

et al. 2021

J Orthop Surg Res

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Background The rate of postoperative infection developing is higher after limb salvage surgery (LSS) following sarcoma resection compared with conventional arthroplasty. The goal of this study is to summarize our experience in management of periprosthetic joint infection (PJI) and the risk factors of early PJI after LSS. Methods Between January 2010 and July 2019, 53 patients with osteosarcoma in the lower extremities who encountered periprosthetic infection after segmental tumor endoprosthetic replacement in our center were analyzed. Detailed patient characteristics and therapeutic information were collected from database of our institution or follow-up data and we divided patients according to the interval time between infection and tumor resection (surgery-infection interval) and investigate potential risk factors. Results A total of 53 (5.08%) patients were suffered postoperative infection. The average interval between surgery and clinical signs of deep infections are 27.5 days. For the drainage culture, positive results were only presented in 11 patients (20.8%). Almost half of this study’s (47.2%) patients underwent a traditional two-stage revision, that was, after the removal of the infected prosthesis, we applied antibiotic-loaded bone cements as a spacer. The mean blood loss during initial implantation surgery and operation time both correlated with interval period between PJI and initial implantation significantly (P = 0.028, P = 0.046). For several patients which infection marker was hardly back to normal after spacer implantation, we conservatively introduced an improved combination of bone cement and prosthesis for the second-stage surgery (5.6%). There were six patients needing re-operation, of which three were due to the aseptic loosening of the prosthesis, one developed periprosthetic infection again, and two patients encountered local recurrence and underwent amputation. Two patients were dead from distal metastasis. Conclusions A two-stage revision strategy remains effective and standardized methods for PJI patients. Total operation time and blood loss during LSS of osteosarcoma are the main risk factors of early PJI. For the patients without confirmed eradiation of microorganisms, an improved combination of bone cement and prosthesis applied in the second-stage surgery could achieve satisfied functional and oncologic results.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

Lin

Jin

et al. 2021

J Orthop Surg Res

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“…19 In early cases without frank pus around the implant, Gundavda et al concluded that debridement and insertion of cement beads would lead to adequate infection control. 20 Surgical site infection often leads to secondary amputation in patients unwilling for multiple surgeries. Miwa et al evaluated the use of iodine coated prosthesis and concluded that though promising further studies are required to evaluate its efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Miwa et al evaluated the use of iodine coated prosthesis and concluded that though promising further studies are required to evaluate its efficacy. 21 Hardes et al reported that when silver coated prosthesis was used, there was an apparent reduction in the infection rate. 22 The limb survival rate in the present study was 92.87% and the implant survival rate was 85.7% at the end of the study period.…”

Section: Discussionmentioning

confidence: 99%

Outcome of modular megaprosthesis in management of Campanacci stage III giant cell tumor around the knee: a prospective study

2021

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Background: Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. The aim of the study was to determine the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed.Methods: Between January 2017 and March 2021, 14 patients in the age group of 28-48 years (mean=42.85 years) with Campanacci stage three giant cell tumors around the knee were studied (12-distal femur patients, 2-proximal tibia). Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb. Results: All the patients were followed up for 12-44 months (mean=29.5 months), the average knee flexion at 6 months being 116.4 degrees. The mean MSTS at 6, 12, 18 and 24 months are 19.45, 23.23, 26.61 and 28.77 respectively. Complications observed were infection and tumor recurrence. Conclusions: In advanced cases where tumor excision leaves large bone segment loss, reconstruction with megaprosthesis can give desirable functional outcome.

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How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery – Surgical technique and case report

Fa-Binefa,

Valera Pertegás,

Peiró Ibañez

et al. 2024

Revista Española de Cirugía Ortopédica y Traumatología

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Fighting Megaprosthetic Infections: What are the Chances of Winning?

Cited by 8 publications

References 45 publications

Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

Outcome of modular megaprosthesis in management of Campanacci stage III giant cell tumor around the knee: a prospective study

How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery – Surgical technique and case report

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