Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer.
Periprosthetic infections of oncologic reconstructions have an amputation rate between 37% and 87%. Eleven patients with an infected knee reconstruction following limb salvage surgery for cancer were treated with the staged protocol. All patients underwent prosthetic removal and implantation of an antibiotic-impregnated cement spacer, i.v. antibiotic therapy, repeat debridement and spacer change, and delayed prosthetic reconstruction and free tissue transfer. At the time of reconstruction, the median bone defect was 185 mm. The mean soft tissue defect was 112 cm2. Coverage was obtained with a free musculocutaneous flap. All limbs were spared without amputation or flap loss. The mean functional outcome as measured by the Musculoskeletal Tumor Society lower extremity score was 23 of 30. Infections of large prosthetic reconstructions about the knee can be salvaged successfully with repetitive debridement, staged prosthetic reimplantation, and free tissue transfer. Free tissue transfer improves the soft tissue envelope and allows restoration of joint motion.


METHODS
Case Series. Level IV.
Manoso
Mark W
MW
Orthopedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, affiliated with the Weill College of Medicine of Cornell University, New York, NY 10021, USA.
Boland
Patrick J
PJ
Healey
John H
JH
Cordeiro
Peter G
PG
D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001859:Bone Neoplasms / Q000601:surgery; D003646:Debridement / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013524:Surgical Flaps; D014184:Transplantation, Homologous