TWO-STAGE REVISION FOR PROSTHESES INFECTION IN PATIENTS WITH BONE TUMOR AFTER KNEE PROSTHETIC REPLACEMENT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Tao , GUO Wei , YANG Rongli , TANG Xiaodong.

Musculoskeletal Tumor Center, People’s Hospital, Peking University, Beijing, 100044, P.R.China.;

Corresponding author：

Keywords：

Tumor prosthesis，Prostheses infection，Two-stage revision，Limb salvage

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【Abstract】 Objective To evaluate the outcome of two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement. Methods Between August 2003 and August 2010, 22 patients with prostheses infection, who underwent knee prosthetic replacement in limb salvage treatment because of bone tumor, received two-stage revision. There were 11 males and 11 females with an average age of 29.6 years (range, 15-55 years). Prosthetic infection occurred after primary replacement in 20 patients and after revision surgery in 2 patients from 15 days to 89 months after operation. According to Coventry and Fitzgerald classification, type I was found in 3 cases, type II in 15 cases, and type III in 4 cases. The time from infection to admission was 5-47 months (mean, 10.2 months). The results of bacterial culture were positive in 9 cases and negative in 13 cases. Two patients had fever and leukocytosis. In one-stage, the implants and infected tissue were removed, and an antibiotic cement spacer with an intramedullary nail was implanted. In two-stage, a new endoprosthesis was inserted after infection was controlled. Results The C-reactive protein and erythrocyte sedimentation rate before one-stage debridement were significantly higher than those before two-stage revision (P lt; 0.05). All patients were followed up 5-63 months (mean, 23.6 months). Infection was controlled after one-stage debridement in 18 cases (81.8%); two-stage revision was performed in 17 cases, and 1 case refused to receive two-stage revision. Of 17 patients, 1 patient was amputated because of infection at 5 months after revision. Four patients (18.2%) underwent amputation because of failure to control infection after one-stage debridement. The limb salvage rate was 77.3% (17/22). One case of renal cell carcinoma with bone metastasis died of original disease after 1 year and 6 months of operation. The Musculoskeletal Tumor Society (MSTS 93) score was 69.4 ± 12.7 at last follow-up. Conclusion Two-stage revision should be performed in time and it has good results in the treatment of prostheses infection in patients with bone sarcomas after knee prosthetic replacement.

Citation： JI Tao,GUO Wei,YANG Rongli,TANG Xiaodong.. TWO-STAGE REVISION FOR PROSTHESES INFECTION IN PATIENTS WITH BONE TUMOR AFTER KNEE PROSTHETIC REPLACEMENT. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(1): 21-25. doi: Copy

1.	of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res, 2010, 468(11): 2885-2895.
2.	treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4): 842-849.
3.	lower extremity tumor endoprostheses. J Arthroplasty, 2007, 22(6): 859-865.
4.	total hip arthroplasty. J Bone Joint Surg (Am), 1977, 59(7): 847-855.
5.	J Bone Joint Surg (Br), 1994, 76(2): 178-186.
6.	endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res, 1999, (358): 64-74.
7.	Knee, 2010, 17(6): 403-406.
8.	treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
9.	bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg (Br), 2005, 87(3): 314-319.
10.	Curr Opin Infect Dis, 2006, 19(4): 349-356.
11.	Shehadeh A, Noveau J, Malawer M, et al. Late complications and survival.
12.	Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients.
13.	Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg, 2006, 126(5): 289-296.
14.	Flint MN, Griffin AM, Bell RS, et al. Two-stage revision of infected uncemented.
15.	Grimer RJ, Belthur M, Chandrasekar C, et al. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res, 2002, (395): 193-203.
16.	Spangehl MJ, Hanssen AD. Management of the infected total knee replacement.Cur Opin Orthop, 2002, 13(1): 23-29.
17.	Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am, 1975, 6(4): 991-1003.
18.	Fitzgerald RH Jr, Nolan DR, Ilstrup DM, et al. Deep wound sepsis following.
19.	Guo W, Ji T, Yang R, et al. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg (Br), 2008, 90(8): 1084-1089.
20.	Gosheger G, Gebert C, Ahren H, et al. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res, 2006, (450): 164-171.
21.	Sim IW, Tse LF, Ek ET, et al. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumors around the knee. Eur J Surg Oncol, 2007, 33(6): 796-802.
22.	Capanna R, Morris HG, Campanacci D, et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur.
23.	Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al. Etiology and results of tumor.
24.	Macmull S, Bartlett W, Miles J, et al. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.
25.	Morii T, Yabe H, Morioka H, et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci, 2010, 15(3): 331-339.
26.	Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging,.
27.	Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted.
28.	Deirmengian C, Greenbaum J, Lotke PA, et al. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty, 2003, 18(7 Suppl 1): 22-26.
29.	Trampuz A, Widmer A. Infections associated with orthopedic implants.
30.	Soriano A, Garcia-Ramiro S, Mensa J. Management of prosthetic joint infection. Reviews in Medical Microbilogy, 2006, 17(2): 55-63.
31.	Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect, 1999, 48: 111-122.

1. of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res, 2010, 468(11): 2885-2895.
2. treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4): 842-849.
3. lower extremity tumor endoprostheses. J Arthroplasty, 2007, 22(6): 859-865.
4. total hip arthroplasty. J Bone Joint Surg (Am), 1977, 59(7): 847-855.
5. J Bone Joint Surg (Br), 1994, 76(2): 178-186.
6. endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res, 1999, (358): 64-74.
7. Knee, 2010, 17(6): 403-406.
8. treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
9. bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg (Br), 2005, 87(3): 314-319.
10. Curr Opin Infect Dis, 2006, 19(4): 349-356.
11. Shehadeh A, Noveau J, Malawer M, et al. Late complications and survival.
12. Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients.
13. Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg, 2006, 126(5): 289-296.
14. Flint MN, Griffin AM, Bell RS, et al. Two-stage revision of infected uncemented.
15. Grimer RJ, Belthur M, Chandrasekar C, et al. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res, 2002, (395): 193-203.
16. Spangehl MJ, Hanssen AD. Management of the infected total knee replacement.Cur Opin Orthop, 2002, 13(1): 23-29.
17. Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am, 1975, 6(4): 991-1003.
18. Fitzgerald RH Jr, Nolan DR, Ilstrup DM, et al. Deep wound sepsis following.
19. Guo W, Ji T, Yang R, et al. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg (Br), 2008, 90(8): 1084-1089.
20. Gosheger G, Gebert C, Ahren H, et al. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res, 2006, (450): 164-171.
21. Sim IW, Tse LF, Ek ET, et al. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumors around the knee. Eur J Surg Oncol, 2007, 33(6): 796-802.
22. Capanna R, Morris HG, Campanacci D, et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur.
23. Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al. Etiology and results of tumor.
24. Macmull S, Bartlett W, Miles J, et al. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.
25. Morii T, Yabe H, Morioka H, et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci, 2010, 15(3): 331-339.
26. Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging,.
27. Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted.
28. Deirmengian C, Greenbaum J, Lotke PA, et al. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty, 2003, 18(7 Suppl 1): 22-26.
29. Trampuz A, Widmer A. Infections associated with orthopedic implants.
30. Soriano A, Garcia-Ramiro S, Mensa J. Management of prosthetic joint infection. Reviews in Medical Microbilogy, 2006, 17(2): 55-63.
31. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect, 1999, 48: 111-122.

Chinese Journal of Reparative and Reconstructive Surgery

TWO-STAGE REVISION FOR PROSTHESES INFECTION IN PATIENTS WITH BONE TUMOR AFTER KNEE PROSTHETIC REPLACEMENT

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