Salvage of infected tumor prostheses

Abstract

Limb salvage in oncologic surgery with endoprosthetic reconstruction results in infection in 5.7–15% of patients. These infections result in subsequent amputation in 46–87% of patients. Through literature review, we evaluated the statistically associated factors, treatments, outcomes and future trends regarding endoprosthetic infection. Infection was more prevalent in periacetabular and proximal tibial reconstructions. Coagulase-negative Staphylococcus was the most common pathogen in seven of eight case series. Factors associated with increased initial and persistent infection included myeloma, radiation therapy, poor soft-tissue condition, revision surgeries, and cementless fixation. Infection was noted to significantly increase 10-year survival in osteosarcoma patients. Recommendations on treatment were mixed, the only significant association with cure was early surgical intervention, and increased salvage rates were seen with both limited one-stage and extensive two-stage procedures. All studies agreed that clinicians and researchers should direct intensive efforts toward the prevention of infection. A number of recent studies showed promising in vitro and in vivo effects of antimicrobial implant surfaces, specifically silver and vancomycin, in retarding the establishment of periprosthetic infection. Infections of oncologic endoprostheses remain challenging problems, with no recent advances in the treatment of established infections. Associated factors have been established, although most are unavoidable in the course of cancer treatment. Most promise comes with the ongoing development of antimicrobial implant surfaces that aim to prevent the establishment and persistence of these difficult infections.