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Staged Management of Infection with Adjustable Spacers After Megaprosthesis Implantation in Primary Sarcoma Patients

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Abstract

Background

While periprosthetic joint infection has always been a significant concern for orthopaedic surgeons, the rate of infection is five to ten times higher after tumor prosthesis implantation. With the growing use of mega-implants, the number of these infections has also increased. We aimed to investigate the results of our patients with a primary malignant musculoskeletal tumor, who underwent two-stage revision surgery for an infected mega-prosthesis. We also presented the emerging complicatons and required soft tissue reconstruction procedures.

Methods

The study included 32 primary bone and soft tissue sarcoma patients who underwent a two-stage revision procedure for infection. After a rigorous bone and soft tissue debridement procedure at the first stage, antibiotic-loaded bone cement was wrapped around a cloverleaf type intramedullary nail and inserted into the forming gap. After a minimum of 6 weeks of antibiotic therapy, depending on patients’ clinical signs and serum infection markers, the reimplantation stage was undertaken.

Results

The mean oncologic follow-up period was 28 months (range 5–96 months). During this period, 11 patients died because of non-infection related causes, 12 patients were alive with their disease, whereas 9 patients were totally free of their oncologic condition. The infection was eradicated in all survivors except one patient, where a high-level transfemoral amputation became necessary.

Conclusion

Periprosthetic infection after tumor proshesis implantation in cancer patients can be managed with same principles as conventional arthroplaty procedures, taking care that they are immunocompromised and vulnerable patients and their bone stock loss is significant which makes surgical options more challenging.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey

    Evrim Şirin, Ömer Sofulu, Özgür Baysal, Ahmet Hamdi Akgülle & Bülent Erol

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  1. Evrim Şirin
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  2. Ömer Sofulu
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  3. Özgür Baysal
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  4. Ahmet Hamdi Akgülle
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  5. Bülent Erol
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Contributions

EŞ, ÖS, ÖB, AHA: designed the study, collected data, assessed the results, wrote the manuscript. BE: designed the study, assessed the results, wrote the manuscript.

Corresponding author

Correspondence to Evrim Şirin.

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Conflict of interest

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article. The authors received no financial support for the research and/or authorship of this article.

Ethical Standard Statement

This study was performed in line with the principles of the Declaration of Helsinki. The study received IRB approval by the institutional review board at the Marmara University School of Medicine (IRB number: 09.2019.863).

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Informed consent was obtained from all individual participants included in the study.

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Şirin, E., Sofulu, Ö., Baysal, Ö. et al. Staged Management of Infection with Adjustable Spacers After Megaprosthesis Implantation in Primary Sarcoma Patients. JOIO 57, 938–947 (2023). https://doi.org/10.1007/s43465-023-00876-9

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  • DOI: https://doi.org/10.1007/s43465-023-00876-9

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