Characteristics and outcome of infections associated with tumor endoprostheses.
BACKGROUND
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.


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.


CONCLUSIONS
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.
Hardes
J
J
Department of Orthopedics, Westfaelische Wilhelms-Universitaet Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany. hardes@uni-munster.de
Gebert
C
C
Schwappach
A
A
Ahrens
H
H
Streitburger
A
A
Winkelmann
W
W
Gosheger
G
G
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D001174:Arthrodesis / Q000379:methods*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000601:surgery; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018213:Neoplasms, Bone Tissue / Q000188:drug therapy / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000601:surgery; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome