Connective Tissue Oncology Society

2001 CTOS Annual Meeting—Oral Presentations

Young Investigator Award Winner
BUGGED OUT? INFECTION AND ENDOPROSTHETIC REPLACEMENTS
Lee M Jeys, Raj Suneja, Vishnu Prasad, Robert Grimer, Simon R Carter, Roger Tillman
Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital

OBJECTIVE: Endoprosthetic replacement (EPR) following surgical excision of Bone Tumours is now common practice. They allow rapid restoration of function, are readily available and have good long term functional scores. However, one of the major complications of EPRs is infection and this can have disastrous consequences. It requires prolonged and expensive treatment, and may result in decreased function, with even a possibility of amputation. This paper aims to investigate the cause of infection, management and its sequalae.

METHODS: Prospective data is collected on all patients seen in our centre and stored on a database. Information collected includes demographic data, diagnosis, site, treatment (including adjuvant), complications, and outcomes. Records over over 10, 000 patient have been kept over 34 years. Data was analysed on all patients who had undergone EPRs, in order to identify any infection, its management and outcome. Factors such as operating time, intra-operative blood loss, adjuvant therapy, type of prosthesis (extendable or standard) were investigated. Outcomes of treatment options were also evaluated.

RESULTS: Over 1260 patients have undergone EPR in our center over 34 years. This gives a total follow up time of over 6500 patient years. Over 200 (16%) patients have been diagnosed with deep infection in their prosthesis (as defined by a positive culture in a clinically infected prosthesis) and of these 38 (25%) required amputations for uncontrollable infection. The commonest procedure for infection control was 2 stage revision. Common organisms involved in infection were Staphylococcus aureus, Streptococcus viridians & epidermidis.

CONCLUSION: Infections are one of the most serious complications to affect EPRs. Treatment can be difficult and prolonged. If early infection is diagnosed immediate lavage and IV antibiotics are recommended. Otherwise 2 stage revision is the only reliable method for limb salvage. Prevention must be the key to reducing the incidence of this serious complication.