Incidence and Outcome after Infection of Megaprostheses

Abstract

Recent advances in chemotherapy and radiation therapy in the treatment of malignant bone tumours as well as the consistent increase of revision arthroplasties have been followed by an increased use of megaprostheses. These large foreign bodies make infection a common and feared complication. Infection rates of 3 - 31% have been reported (average approx. 15%), often in conjunction with risk factors, e.g. the anatomic region (pelvis implants in particular), implant alloy, and underlying reason for implantation of a megaprosthesis. Apart from the basic principles of septic revision arthroplasty, special patient and implant factors have to be considered in infected megaprosthesis, which we have summarised in our paper (e.g. life expectancy, implant design, spacers and external stabilisation). This article further analyses the current literature available for these cases and summarises outcome after treatment of periprosthetic infections.

The modified Harrington procedure for metastatic peri-acetabular bone destruction

“…A recent study by Jansen et al reported a high risk of complications and poor long-term function in patients following acetabular reconstruction with saddle prostheses after peri-acetabular tumour surgery [15]. Another technique of endoprosthetic restoration, especially in relation to reconstruction of extended pelvic defects in cases of primary malignant tumours or solitary metastatic bony lesions of the pelvis, is the internal hemipelvectomy and reconstruction with an endoprosthetic pelvic replacement [9,[16][17][18][19]. Although this technique, first described in 1978, has been improved due to the possibility of exact planning of resection and construction of the implants using threedimensional imaging, the functional outcome has been described as limited to poor.…”

“…Although this technique, first described in 1978, has been improved due to the possibility of exact planning of resection and construction of the implants using threedimensional imaging, the functional outcome has been described as limited to poor. Furthermore, this technique seems to be associated with a high incidence of postoperative complications, such as deep infection and dislocation [9,[17][18][19].…”

Management of infection following reconstruction in bone tumors

“…An analysis of the literature shows that besides the occurrence of a local recurrence, periprosthetic infection remains the most serious complication following limb salvage procedure with megaprosthesis. 37,6,38 Infection of a megaprosthesis ( Fig. 2) implanted following tumor resection leads to major morbidity and sometimes amputation.…”

“…the anatomic region (pelvis implants in particular), implant alloy, and underlying reason for implantation of a megaprosthesis. 37 The rate of infections varies according to the site of replacement with lower rates in upper extremities and higher rates in lower extremities. [39][40][41][42][43][44] However postsurgical infection is more common in pelvic tumor surgeries.…”

“…Other factors include prolonged operating time, wide surgical exposure, use of chemotherapy/radiotherapy, proximity of the rectum and genitourinary tract, size of the implant, and blood supply to the skin flap. 37,6,39,[45][46][47][48] Regarding infection rates with regard to specific diagnosis, sarcomas demonstrated the highest infection rate of 21.7% when compared to metastatic or non-metastatic disease (Table 2). 36 Usually high infection rates are seen after …”