Issue
SICOT-J
Volume 10, 2024
Special issue: "Bone and joint infections"
Article Number 19
Number of page(s) 9
Section Hip
DOI https://doi.org/10.1051/sicotj/2024008
Published online 30 May 2024

© The Authors, published by EDP Sciences, 2024

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

The evolution of megaprostheses has markedly assisted in the reconstruction of large bone defects subsequent to the resection of bone tumors or soft tissue tumors invading bone for optimal function of the limb [1]. Peri-megaprosthetic joint infections (PJI) are many challenging complications that can occur following the use of a megaprosthesis in limb salvage surgery and may result in severe consequences [2]. With megaprosthetic reconstruction after tumor resection, the mean rate of PJI of a megaprosthesis is approximately 10% after the primary procedure, while it can be up to 60% after revision operations [3, 4]. Immunosuppression resulting from chemotherapy and radiation therapy, the presence of a substantial anatomical dead space after tumor resection, the absence of soft tissue structures for ideal wound coverage, extended operating hours, and mega implants are several significant factors that contribute to a high risk of PJI [3, 5].

Tumor patients with PJI after limb salvage surgery and megaprosthetic reconstruction often require staged revision surgeries and long-term intravenous antibiotic therapy; PJI-delayed adjuvant tumor treatments deteriorate patients’ quality of life and remaining life. In approximately 20% of cases, PJI of oncological prostheses leads to failure of the reconstruction or amputation of the limb [6]. Current therapeutic approaches for PJI include debridement-administration of antibiotics-irrigation-implant retention (DAIR), megaprosthesis revision (one or two stages), arthrodesis facilitated, and in select cases such as significant bone defect, lack of a bacterial isolate, and/or local tumor recurrence, amputation. The available clinical data pertaining to the outcome of these interventions for the management of the PJI are limited [7]; the prevailing method seems to be the two-stage revision operation [8]. Given the severe consequences associated with this severe condition, treatment strategies aiming to limit infection risk and optimize quality of life are of great importance.

This review article aims to comprehensively identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery.

Materials and methods

The present systematic review was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analysis [9]. A study protocol was designed and studies eligible for inclusion were identified through a thorough electronic systematic search of PubMed and Cochrane Library from February to April 30, 2023. The following search terms were utilized: ((“oncology” [All Fields]) OR (“tumor” [All Fields]) OR (“tumour” [All Fields]) OR (“neoplasm” [All Fields]) OR (“cancer” [All Fields]) OR (“limb salvage” [All Fields])) AND ((“prosthesis” [All Fields]) OR (“megaprosthesis” [All Fields]) OR (“endoprosthesis” [All Fields]) OR (“megaprostheses” [All Fields]) OR (“endoprostheses” [All Fields]) OR (“tumor endoprostheses” [All Fields])) AND ((“infection” [All Fields]) OR (“periprosthetic joint infection” [All Fields]) OR (“complication” [All Fields]) OR (“implant failure” [All Fields])). The search was restricted to articles published in the English language, with no limitations imposed on study types during the preliminary screening phase. Two authors independently performed the literature screening. Reviews and meta-analysεs were also analyzed aiming to expand the search for studies that might have not been detected by the electronic search methodology.

Studies that reported rates of PJI in tumor patients undergoing limb-salvage surgery and investigated risk factors for infection were considered eligible. Studies reporting outcomes of megaprosthetic reconstruction for non-oncologic conditions, case reports, editorials, and letters to the editors were excluded. For duplicates, only the most recent or most informative study was used.

The results generated by the primary search algorithm and the stages of the selection process were delineated in a flowchart (Figure 1). Overall, a total of 2.845 studies were initially identified. Based on their titles 2.319 were excluded, leaving 526 studies for review. Their abstracts were subsequently assessed for relevance to our clinical inquiry, leading to the exclusion of 464 additional studies. Full-text articles were then obtained and thoroughly examined for the remaining 62 studies. Following a search of references, six full texts were added. Of these, 53 studies were further excluded due to the inability to extract relevant data concerning potential risk factors for prosthesis infection. Any discrepancies were solved after team consensus.

thumbnail Figure 1

Flowchart and selection process of the included studies.

After exclusions, a total of 15 studies were left for review [2, 1023]. All the studies included in the analysis underwent thorough evaluation, and relevant data pertaining to areas of interest were extracted and summarized (Table 1). Publication dates of the included studies ranged from 2005 to 2022 and sample sizes varied from 81 to 1240 patients.

Table 1

Characteristics and reported risk factors of the included studies.

Variables of interest included general study characteristics (e.g. authors, year of publication, study design, country of enrollment, level of evidence, and number of patients), patient demographics (e.g. age, gender), oncological diagnosis, type of prosthesis, PJI rate, bacterial isolates, prophylactic antibiotic regimens, megaprostheses survival without infection and risk factors for PJI.

Results

Eleven of the included studies in this review were retrospective in nature, presenting outcomes related to PJI after tumor resection and megaprosthetic reconstruction [11, 12, 14, 15, 1723]. Two studies specifically compared results between patients with silver-coated and titanium prostheses. The silver-coated group was prospectively examined in both studies [13, 16]. Additionally, one study conducted a retrospective and prospective analysis focused on a specific time point [2]. Importantly, only one study maintained a prospective follow-up of their study group [10]. A total of 4.445 patients were included in all studies with a mean age of 35.78 years (range, 4–95 years). The mean follow-up of the patients ranged from 17 months [16] to 10.3 years [15]. Five studies included megaprosthetic reconstruction for tumors of the femur, tibia, and humerus [10, 14, 17, 20, 23], while three studies included megaprosthetic reconstruction for tumors of the lower extremity. Two studies focused on the outcomes of proximal femoral replacement [13, 21], one study on the outcomes of the proximal tibia [16], and another study on the outcomes of the total femur resection and reconstruction [15].

The mean rate of PJI was 13.77%, ranging from 7.2% to 32% among the included studies. The most common types of megaprostheses that sustained an infection were proximal tibia and distal femur megaprostheses. Concerning tumor diagnoses, osteosarcoma, chondrosarcoma, Ewing’s sarcoma, giant cell tumor of bone, and metastatic bone disease were most frequently encountered. Nine studies included in their analysis the perioperative antibiotic regimen that was administered (Table 2) [2, 10, 13, 1618, 20, 22, 23]. As for the reported bacterial isolates, the predominant causative agents for the infections were coagulase-negative staphylococci and Staphylococcus aureus (including methicillin-resistant strains); several infections were multimicrobial.

Table 2

Summary of published studies reporting on antibiotics regimens for perioperative prophylaxis.

Age has not been associated with increased risk for PJI in any of the included studies [2, 10, 12, 22]. Although, most of the studies that investigated gender as a potential risk factor for PJI found no correlation [2, 17, 22], one study reported that male sex was a significant risk factor [12]. Patients with various comorbidities and increased Charlson Comorbidity Index (CCI) [10], as well as those with increased bone mass index (BMI), experienced a higher PJI risk [20]. Although only one study concluded that metastatic bone disease was associated with a higher risk for PJI [18], in all other studies the patients diagnosed with primary bone or soft tissue tumors experienced a higher risk for PJI [1012, 19, 21]. Soft-tissue tumors extending into adjacent bone were found to be a significant risk factor in one study [12], while myeloma was also reported in another study [2]. The primary tumor diagnoses of osteosarcoma or Ewing’s sarcoma did not demonstrate a correlation with worse survival rates without PJI when compared to other types of sarcomas [18].

The implementation of any adjuvant therapy for the treatment of malignancy was shown to increase the possibility of infection [14, 18]; specifically, four studies reported that radiotherapy was a significant risk factor for PJI [2, 12, 13, 19]. Chemotherapy has been associated with a higher risk for PJI in one study [19], while in others it did not seem to be associated with increased rates of infection [2, 11, 12, 15, 20, 22]. Tumor location and reconstruction in the tibia [2, 14, 17] and the pelvis [2, 17] notably increased the risk of PJI. However, the length of bone resection prior to megaprosthetic reconstruction has not been found to predict a higher risk of PJI in two studies that investigated this variable [11, 22]. Additional reconstruction of the pelvis in cases of proximal femur replacement was a significant risk factor for PJI in one study [21]. In another study, knee megaprosthetic reconstruction was related to an increased risk for PJI compared to hip megaprosthetic reconstruction [10]. In cases of distal femur replacement, the extra-articular resection of the tumor prior to reconstruction [23] and the resection of more than three heads of the quadriceps in order to achieve wider surgical margins were significantly related to an increased risk of PJI [22]. One study with total femur reconstruction identified a poor range of motion postoperatively (0°–45° degrees of flexion) as a significant risk factor for PJI [15].

The relationship between PJI and implant coating has been previously reported [1016]. One study found that the use of non-silver-coated implants in megaprosthetic reconstruction was associated with an increased risk for PJI [10], while in two other studies, the risk for PJI was the same regardless of the use of silver coating [14, 15]. Although superior implant survival rates without infection at 5 years were achieved with silver-coated megaprostheses, statistical analysis did not identify the implantation of a titanium prosthesis as a risk factor for PJI [13, 16].

Previous surgery prior to limb salvage and megaprosthetic reconstruction was found to be a significant risk factor for infection in four studies [12, 1416]. These previous operations consisted of soft-tissue tumor resection and femoral fracture osteosynthesis [12], as well as prior curettage [12, 16]. Additional surgical interventions were also found to be significant risk factors in two studies [2, 17]. The utilization of expandable prostheses in pediatric tumor patients [2] coupled with subsequent lengthening procedures has been related to a higher risk for PJI [17]. In contrast, a separate study revealed that revision surgery resulting from mechanical failures did not increase the susceptibility to infection [16]. An increased risk for infection was found for patients who experienced wound healing complications postoperatively [16, 20, 22], including wound necrosis and superficial infection [22], and postoperative hematoma formation [20].

Several procedure-related factors were investigated in the included studies. Three studies reported that increased operating time was a significant risk factor for PJI [12, 16, 20]; one study found that operation time over a cut-off value of 493 min significantly increased the risk of PJI [12]. Preoperative hospitalization >2 days [17], as well as admission to the intensive care unit [20] have also been related to higher rates of PJI. The need for blood transfusion [20] and transfusion of more than two blood units [17] were also found significant risk factors.

Discussion

Peri-megaprosthetic joint infections are challenging complications in limb salvage surgery for musculoskeletal tumors, with several risk factors contributing to a high risk for PJI. We performed this review to comprehensively identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery. Our findings showed a multifaceted nature of PJI in megaprosthetic reconstructions in tumor surgery, with key factors contributing to infection including surgical site characteristics, patients’ demographics, and procedure-related factors. Although similar investigations have already been made clear in a number of relevant, well-published studies, we believe that listing and analyzing these up-to-date published studies in a well-designed review article with systematic as well as narrative methodology is didactive and educative, as well as useful in clinical practice for optimal decision making in patients’ management.

The diagnosis and management of PJI typically involves a comprehensive assessment, including clinical evaluation, laboratory tests, and imaging studies to accurately identify and address potential infections around the prosthetic joint [2430]. It may lead to a significant decline in patient health status, prolonged hospitalization, and unfavorable functional outcomes and prognosis [3133]. Novel surgical techniques and antibiotic regimens are also necessary to be implemented in order to successfully manage this complication [3437]. In this systematic review, we attempted to investigate potential risk factors for PJI in tumor surgery with megaprosthetic reconstruction. These factors may be related to patient characteristics, comorbidities, and medical conditions due to the malignancy or the surgical technique.

Megaprosthetic reconstructions after tumor resection have shown higher rates of PJI compared to conventional arthroplasty [18, 3840]. In our analysis, we found that surgery for primary tumors, male gender, long operation time, radiation therapy, previous surgery, tibial and pelvic site of reconstruction, wound healing complications, intensive care unit admission, blood transfusion, and prolonged hospitalization were significant factors that increase the risk for PJI in tumor surgery [2, 1014, 16, 17, 19, 20]. Leukocytopenia and neutropenia resulting from chemotherapy, along with tissue damage by radiation therapy may significantly influence the occurrence of PJI. However, the association of these adjuvant therapies remains controversial [41]. Patients who received chemotherapy reported higher overall revision rates compared to those who did not [42]. Several studies conclude that chemotherapy is not related to higher PJI rates [2, 11, 15, 20, 22], while other studies report that chemotherapy is a significant risk factor for PJI in tumor surgery [14, 19]. Although not statistically significant, survival from infection of tumor prosthesis was slightly better for patients who received radiation therapy or chemotherapy compared to those who did not with a survival rate of 88% and 90% at 10 years, respectively [18]. In a large study including 1264 tumor patients who underwent limb salvage surgery, a PJI rate of 11% was reported. Radiation therapy was a significant risk factor, as 20.7% and 35.3% of the patients who had pre- and post-operative radiation therapy, respectively, experienced a PJI compared to 9.8% of the patients who did not [2]. These results are in accordance with other similar studies [1214, 19].

Knee megaprosthetic reconstructions have been associated with a higher risk for PJI compared to hip reconstructions [10]. Extra-articular resection with distal femur replacement showed a 6.2-fold risk for PJI compared to intra-articular resection [23]. Cementless fixation and rotating-hinge knee implants might also increase the infection rate in distal femur replacement [43]. Higher risks for PJI are anticipated in pelvic and proximal tibia resections and reconstructions as it has been found to be a significant risk factor [2, 14, 17, 21, 44]. Especially in proximal tibia resections and reconstructions, the risk of PJI is higher because of challenges in adequate soft tissue coverage [16, 45]. Since the routine use of a gastrocnemius rotation flap became a standard technique, the infection rate reduced from 36% to 12%. This significant improvement in the occurrence of infection is attributed to the better muscle coverage achieved with the flap [46]. Another study reported that resection of >37% of the tibia and resection length of >12.5 cm are associated with a higher risk for implant failure due to PJI [47]. Long operation time, extensive exposures, and residual dead space may significantly increase infection rates in the pelvis [2, 17, 21, 47, 48].

Antibiotic-loaded cement is routinely used for implant fixation in megaprosthetic reconstructions. Nevertheless, the literature presents highly diverse findings concerning the correlation between infection rates and cemented or cementless fixation in tumor surgery [31]. Cemented fixation posed a higher risk of infection in two large-scale studies compared to cementless fixation [18, 21]. In contrast, cementless fixation of prostheses showed significantly better overall survival and survival to infection compared to cemented fixation in another study. In that study, survival to infection was 68% and 82% at 60 months for cemented and cementless fixation, respectively [49].

The efficacy and safety of silver as an antibacterial coating on implants in order to reduce the incidence of PJI and improve outcomes of treatment of PJI is a matter of study during the past years [50, 51]. A recent comprehensive meta-analysis indicated a relative protective effect of silver coating in PJI prevention in megaprosthetic reconstructions. In particular, overall infection in primary silver-coated and uncoated implants was 9.2% and 11.2%, respectively. Moreover, optimal results with silver-coated implants were obtained in proximal femur replacements [52]. Two studies showed better implant survival without infection at 5 years in silver-coated prostheses [13, 16]. The use of uncoated implants in knee megaprosthetic reconstructions after tumor resection increased the risk of infection in another study [10].

We see two limitations in this study. First, the majority of the included studies are retrospective (Level of Evidence III or IV), with not all-encompassing study variables. Second, there is significant variability in the statistical methods employed across the studies. Consequently, obtaining more secure and unequivocal results, as well as facilitating comparisons between potential risk factors, presented increased challenges. We acknowledge these limitations; however, we believe that the study design and inclusion of retrospective studies are useful for decision-making in clinical practice.

Conclusions

The comprehensive analysis of risk factors for PJI in tumor surgery may contribute to a better understanding of the challenges associated with these complex procedures and the management of PJI. Key factors contributing to infection risk include surgical site characteristics, patients’ demographics, and procedure-related factors. The present systematic review emphasized the multifaceted nature of PJI in megaprosthetic reconstructions in tumor surgery. The identification of poor outcomes and treatment-related challenges further highlights the urgency for tailored interventions. The integration of individualized risk assessments and personalized preventive measures to enhance the success of megaprosthetic reconstructions in tumor surgery is paramount.

Funding

This research did not receive any specific funding

Conflicts of interest

The authors declare that they have no relevant financial or non-financial interests to report.

Data availability statement

Data are available on request from the authors.

Author contribution statement

All authors contributed equally to conceiving and designing the analysis, searching the literature, collecting the data, performing the analysis, writing the paper, editing and reviewing the paper, submission and review of the paper.

Ethics approval

Ethical approval was not required.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review. J Bone Joint Surg 93, 418–429. [Google Scholar]
  2. Jeys LM, Grimer RJ, Carter SR, Tillman RM (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. JBJS 87(4), 842–849. [Google Scholar]
  3. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M (2013) High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: A systematic review. Clin Orthop 471, 2017–2027. [Google Scholar]
  4. Shehadeh A, Noveau J, Malawer M, Henshaw R (2010) Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop 468, 2885–2895. [Google Scholar]
  5. Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C (2010) Infection following bone tumor resection and reconstruction with tumoral prostheses: A literature review. Int J Immunopathol Pharmacol 23, 1005–1013. [Google Scholar]
  6. Jeys L, Grimer R (2009) The long-term risks of infection and amputation with limb salvage surgery using endoprostheses, in Treatment of Bone and Soft Tissue Sarcomas. Tunn P-U, Editor. Springer: Berlin, Heidelberg. pp. 75–84. [Google Scholar]
  7. Kapoor SK, Thiyam R (2015) Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma 6, 244–251. [Google Scholar]
  8. Hardes J, Ahrens H, Gosheger G, Nottrott M, Dieckmann R, Henrichs M-P, Streitbürger A. (2014) Komplikationsmanagement bei Megaprothesen. Unfallchirurg 117, 607–613. [Google Scholar]
  9. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol 62, 1006–1012. [Google Scholar]
  10. Khakzad T, Karczewski D, Thielscher L, Reiter K, Wittenberg S, Paksoy A, Flörcken A, Rau D, Märdian S (2022) Prosthetic joint infection in mega-arthroplasty following shoulder, hip and knee malignancy – a prospective follow-up study. Life 12, 2134. [Google Scholar]
  11. Berger C, Larsson S, Bergh P, Brisby H, Wennergren D (2021) The risk for complications and reoperations with the use of mega prostheses in bone reconstructions. J Orthop Surg 16, 598. [Google Scholar]
  12. Fujiwara T, Ebihara T, Kitade K, Setsu N, Endo M, Iida K, Matsumoto Y, Matsunobu T, Oda Y, Iwamoto Y, Nakashima Y (2020) Risk factors of periprosthetic infection in patients with tumor prostheses following resection for musculoskeletal tumor of the lower limb. J Clin Med 9, 3133. [Google Scholar]
  13. Streitbuerger A, Henrichs MP, Hauschild G, Nottrott M, Guder W, Hardes J (2019) Silver-coated megaprostheses in the proximal femur in patients with sarcoma. Eur J Orthop Surg Traumatol 29, 79–85. [Google Scholar]
  14. Parry MC, Laitinen MK, Albergo JI, Gaston CL, Stevenson JD, Grimer RJ, Jeys LM (2019) Silver-coated (Agluna®) tumour prostheses can be a protective factor against infection in high risk failure patients. Eur J Surg Oncol 45, 704–710. [Google Scholar]
  15. Medellin MR, Fujiwara T, Clark R, Stevenson JD, Parry M, Jeys L (2019) Mechanisms of failure and survival of total femoral endoprosthetic replacements. Bone Joint J. 101-B, 522–528. [Google Scholar]
  16. Hardes J, Henrichs MP, Hauschild G, Nottrott M, Guder W, Streitbuerger A (2017) Silver-coated megaprosthesis of the proximal tibia in patients with sarcoma. J Arthroplasty 32, 2208–2213. [Google Scholar]
  17. Dhanoa A, Ajit Singh V, Elbahri H (2015) Deep infections after endoprosthetic replacement operations in orthopedic oncology patients. Surg Infect 16, 323–332. [Google Scholar]
  18. Mavrogenis AF, Pala E, Angelini A, Calabro T, Romagnoli C, Romantini M, Drago G, Ruggieri P (2015) Infected prostheses after lower-extremity bone tumor resection: Clinical outcomes of 100 patients. Surg Infect 16, 267–275. [Google Scholar]
  19. Allison D, Huang E, Ahlmann ER, Carney S, Wang L, Menendez LR (2014) Peri-prosthetic infection in the orthopedic tumor patient. Reconstr Rev 4, 13–22. [Google Scholar]
  20. Peel T, May D, Buising K, Thursky K, Slavin M, Choong P (2014) Infective complications following tumour endoprosthesis surgery for bone and soft tissue tumours. Eur. J. Surg. Oncol. 40, 1087–1094. [Google Scholar]
  21. Funovics PT, Hipfl C, Hofstaetter JG, Puchner S, Kotz RI, Dominkus M (2011) Management of septic complications following modular endoprosthetic reconstruction of the proximal femur. Int Orthop 35, 1437–1444. [Google Scholar]
  22. Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, Takeda K, Kikuta K, Hosaka S, Yazawa Y, Takeuchi K, Anazawa U, Mochizuki K, Satomi K (2010) Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci 15, 331–339. [Google Scholar]
  23. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop 450, 164–171. [Google Scholar]
  24. Theil C, Schwarze J, Gosheger G, Moellenbeck B, Schneider KN, Deventer N, Klingebiel S, Grammatopoulos G, Boettner F, Schmidt-Braekling T (2022) Implant survival, clinical outcome and complications of megaprosthetic reconstructions following sarcoma resection. Cancers 14, 351. [Google Scholar]
  25. Holm CE, Soerensen MS, Yilmaz M, Petersen MM (2022) Evaluation of tumor-prostheses over time: Complications, functional outcome, and comparative statistical analysis after resection and reconstruction in orthopedic oncologic conditions in the lower extremities. SAGE Open Med 10, 205031212210941. [Google Scholar]
  26. Pannu TS, Villa JM, Higuera CA (2021) Diagnosis and management of infected arthroplasty. SICOT J 7, 54. [Google Scholar]
  27. Sambri A, Maso A, Storni E, Megaloikonomos PD, Igoumenou VG, Errani C, Mavrogenis AF, Bianchi G (2019) Sonication improves the diagnosis of megaprosthetic infections. Orthopedics 42, 28–32. [Google Scholar]
  28. Izakovicova P, Borens O, Trampuz A (2019) Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 4, 482–494. [Google Scholar]
  29. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop 469, 2992–2994. [Google Scholar]
  30. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR (2013) Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56, e1–e25. [Google Scholar]
  31. Tsantes AG, Altsitzioglou P, Papadopoulos DV, Lorenzo D, Romanò CL, Benzakour T, Tsukamoto S, Errani C, Angelini A, Mavrogenis AF (2023) Infections of tumor prostheses: An updated review on risk factors, microbiology, diagnosis, and treatment strategies. Biology 12, 314. [Google Scholar]
  32. Mavrogenis AF, Papagelopoulos PJ, Coll-Mesa L, Pala E, Guerra G, Ruggieri P (2011) Infected tumor prostheses. Orthopedics 34, 991–998. [Google Scholar]
  33. Ferry T, Batailler C, Brosset S, Kolenda C, Goutelle S, Sappey-Marinier E, Josse J, Laurent F, Lustig S, On Behalf of the Lyon BJI Study Group (2020) Medical innovations to maintain the function in patients with chronic PJI for whom explanation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach. SICOT J 6, 26. [Google Scholar]
  34. Bolia IK, Tsiodras S, Chloros GD, Kaspiris A, Sarlikiotis T, Savvidou OD, Papagelopoulos PJ (2018) A review of novel antibiotic regimens for the treatment of orthopedic infections. Orthopedics 41, 323–328. [Google Scholar]
  35. Qasim SN, Swann A, Ashford R (2017) The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review. SICOT J 3, 2. [Google Scholar]
  36. Gundavda MK, Katariya A, Reddy R, Agarwal MG (2020) Fighting megaprosthetic infections: What are the chances of winning? Indian J Orthop 54, 469–476. [Google Scholar]
  37. Bejon P, Berendt A, Atkins BL, Green N, Parry H, Masters S, Mclardy-Smith P, Gundle R, Byren I (2010) Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. J Antimicrob Chemother 65, 569–575. [Google Scholar]
  38. Gitelis S, Yergler JD, Sawlani N, Schiff A, Shott S (2008) Short and long term failure of the modular oncology knee prosthesis. Orthopedics 31, 362. [Google Scholar]
  39. Sukeik M, Haddad FS (2019) Periprosthetic joint infections after total hip replacement: an algorithmic approach. SICOT J 5, 5. [CrossRef] [EDP Sciences] [PubMed] [Google Scholar]
  40. Fontalis A, Berry DJ, Shimmin A, Slullitel PA, Buttaro MA, Li C, Malchau H, Haddad FS (2021) Prevention of early complications following total hip replacement. SICOT J 7, 61. [Google Scholar]
  41. Miwa S, Shirai T, Yamamoto N, Hayashi K, Takeuchi A, Tada K, Kajino Y, Inatani H, Higuchi T, Abe K, Taniguchi Y, Tsuchiya H (2017) Risk factors for postoperative deep infection in bone tumors. PLOS One 12, e0187438. [Google Scholar]
  42. Pugh LR, Clarkson PW, Phillips AE, Biau DJ, Masri BA (2014) Tumor endoprosthesis revision rates increase with peri-operative chemotherapy but are reduced with the use of cemented implant fixation. J Arthroplasty 29, 1418–1422. [Google Scholar]
  43. Haijie L, Dasen L, Tao J, Yi Y, Xiaodong T, Wei G (2018) Implant survival and complication profiles of endoprostheses for treating tumor around the knee in adults: a systematic review of the literature over the past 30 years. J Arthroplasty 33, 1275–1287. [Google Scholar]
  44. De Gori M, Gasparini G, Capanna R (2017) Risk factors for perimegaprosthetic infections after tumor resection. Orthopedics 40, e11–e16. [Google Scholar]
  45. Mavrogenis AF, Pala E, Angelini A, Ferraro A, Ruggieri P (2013) Proximal tibial resections and reconstructions: Clinical outcome of 225 patients. J Surg Oncol 107, 335–342. [Google Scholar]
  46. Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br 81-B, 488–494. [Google Scholar]
  47. Cho WH, Song WS, Jeon D-G, Kong C-B, Kim JI, Lee S-Y (2012) Cause of infection in proximal tibial endoprosthetic reconstructions. Arch Orthop Trauma Surg 132, 163–169. [Google Scholar]
  48. Ozaki T, Hoffmann C, Hillmann A, Gosheger G, Lindner N, Winkelmann W (2002) Implantation of hemipelvic prosthesis after resection of sarcoma. Clin Orthop 396, 197–205. [Google Scholar]
  49. Pala E, Mavrogenis AF, Angelini A, Henderson ER, Douglas Letson G, Ruggieri P (2013) Cemented versus cementless endoprostheses for lower limb salvage surgery. J Balk Union Oncol 18, 496–503. [Google Scholar]
  50. Lex JR, Koucheki R, Stavropoulos NA, Michele JD, Toor JS, Tsoi K, Ferguson PC, Turcotte RE, Papagelopoulos PJ (2022) Megaprosthesis anti-bacterial coatings: A comprehensive translational review. Acta Biomater 140, 136–148. [Google Scholar]
  51. Savvidou OD, Kaspiris A, Trikoupis I, Kakouratos G, Goumenos S, Melissaridou D, Papagelopoulos PJ (2020) Efficacy of antimicrobial coated orthopaedic implants on the prevention of periprosthetic infections: A systematic review and meta-analysis. J Bone Joint Infect 5, 212–222. [Google Scholar]
  52. Fiore M, Sambri A, Zucchini R, Giannini C, Donati DM, De Paolis M (2021) Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: A systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery. Eur J Orthop Surg Traumatol 31, 201–220. [Google Scholar]

Cite this article as: Karampikas V, Gavriil P, Goumenos S, Trikoupis IG, Roustemis AG, Altsitzioglou P, Kontogeorgakos V, Mavrogenis AF & Papagelopoulos PJ (2024) Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review. SICOT-J 10, 19

All Tables

Table 1

Characteristics and reported risk factors of the included studies.

Table 2

Summary of published studies reporting on antibiotics regimens for perioperative prophylaxis.

All Figures

thumbnail Figure 1

Flowchart and selection process of the included studies.

In the text

Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.

Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.

Initial download of the metrics may take a while.