Skip to main content
SpringerLink
Log in

Management of Postoperative Infection After Limb Salvage Surgery in Osteosarcoma Patients

  • Chapter
  • First Online:
Osteosarcoma

  • 1386 Accesses

Abstract

Postoperative infection is one of the most severe complications associated with limb salvage surgery in osteosarcoma patients. The incidence of infection is approximately ten times higher than that of conventional orthopedic surgery, and the impact of infection on limb survival and functional loss is significant. Due to the paucity of the surrounding soft tissue, the local conditions of limb salvage surgery for osteosarcoma patients and the pathophysiological mechanisms of infection are specific. Accordingly, preventative strategies should be based both on general guidelines on surgical site infection and on the specific properties of infection associated with orthopedic oncological surgery. Various treatment modalities and their success rates have been reported, and it has been found that the selection of management strategy should be based on both soft tissue conditions and infection conditions, with particular focus on the intensity, establishment period, and extension area of an infection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci. 2010;15:331–9.

    Article  PubMed  Google Scholar 

  2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132.

    Article  CAS  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention. National Healthcare Safety Network. Surgical Site Infection (SSI) Event. 2013. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 17 June 2013.

  4. Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am. 2005;87:842–9.

    Article  CAS  PubMed  Google Scholar 

  5. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg. 2006;126:289–96.

    Article  CAS  PubMed  Google Scholar 

  6. Morii T, Morioka H, Ueda T, Araki N, Hashimoto N, Kawai A, et al. Deep infection in tumor endoprosthesis around the knee: a multi-institutional study by the Japanese musculoskeletal oncology group. BMC Musculoskelet Disord. 2013;14:51.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Minnema B, Vearncombe M, Augustin A, Gollish J, Simor AE. Risk factors for surgical-site infection following primary total knee arthroplasty. Infect Control Hosp Epidemiol. 2004;25:477–80.

    Article  PubMed  Google Scholar 

  8. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–54.

    Article  CAS  PubMed  Google Scholar 

  9. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res. 2013;471:2017–27.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bus MP, Dijkstra PD, van de Sande MA, Taminiau AH, Schreuder HW, Jutte PC, et al. Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Joint Surg Am. 2014;96:e26.

    Article  CAS  PubMed  Google Scholar 

  11. Igarashi K, Yamamoto N, Shirai T, Hayashi K, Nishida H, Kimura H, et al. The long-term outcome following the use of frozen autograft treated with liquid nitrogen in the management of bone and soft-tissue sarcomas. Bone Joint J. 2014;96-B:555–61.

    Article  CAS  PubMed  Google Scholar 

  12. Niethard M, Tiedke C, Andreou D, Traub F, Kuhnert M, Werner M, et al. Bilateral fibular graft: biological reconstruction after resection of primary malignant bone tumors of the lower limb. Sarcoma. 2013;2013:205832.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Aponte Tinao L, Farfalli GL, Ritacco LE, Ayerza MA, Muscolo DL. Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res. 2012;470:728–34.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Sugiura H, Nishida Y, Nakashima H, Yamada Y, Tsukushi S, Yamada K. Evaluation of long-term outcomes of pasteurized autografts in limb salvage surgeries for bone and soft tissue sarcomas. Arch Orthop Trauma Surg. 2012;132:1685–95.

    Article  PubMed  Google Scholar 

  15. Poffyn B, Sys G, Mulliez A, Van Maele G, Van Hoorebeke L, Forsyth R, et al. Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks. Int Orthop. 2011;35:889–95.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Puri A, Gulia A, Agarwal M, Jambhekar N, Laskar S. Extracorporeal irradiated tumor bone: a reconstruction option in diaphyseal Ewing’s sarcomas. Indian J Orthop. 2010;44:390–6.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ogilvie CM, Crawford EA, Hosalkar HS, King JJ, Lackman RD. Long-term results for limb salvage with osteoarticular allograft reconstruction. Clin Orthop Relat Res. 2009;467:2685–90.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Tsuchiya H, Abdel Wanis ME, Tomita K. Biological reconstruction after excision of juxta-articular osteosarcoma around the knee: a new classification system. Anticancer Res. 2006;26:447–53.

    PubMed  Google Scholar 

  19. Muscolo DL, Ayerza MA, Aponte Tinao LA, Ranalletta M. Use of distal femoral osteoarticular allografts in limb salvage surgery. J Bone Joint Surg Am. 2005;87:2449–55.

    Article  PubMed  Google Scholar 

  20. Manabe J, Ahmed AR, Kawaguchi N, Matsumoto S, Kuroda H. Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res. 2004;419:258–66.

    Google Scholar 

  21. Muscolo DL, Ayerza MA, Aponte Tinao LA, Ranalletta M. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 2004;86-A:2686–93.

    PubMed  Google Scholar 

  22. Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I et al. Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res. 1999;368:196–206.

    Google Scholar 

  23. Bernthal NM, Schwartz AJ, Oakes DA, Kabo JM, Eckardt JJ. How long do endoprosthetic reconstructions for proximal femoral tumors last? Clin Orthop Relat Res. 2010;468:2867–74.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008;90:1265–71.

    Article  CAS  PubMed  Google Scholar 

  25. Guo W, Ji T, Yang R, Tang X, Yang Y. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg Br. 2008;90:1084–9.

    Article  CAS  PubMed  Google Scholar 

  26. Sim IW, Tse LF, Ek ET, Powell GJ, Choong PF. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumours around the knee. Eur J Surg Oncol. 2007;33:796–802.

    Article  PubMed  Google Scholar 

  27. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. 2006;450:164–71.

    Article  PubMed  Google Scholar 

  28. Orlic D, Smerdelj M, Kolundzic R, Bergovec M. Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment. Int Orthop. 2006;30:458–64.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Heisel C, Kinkel S, Bernd L, Ewerbeck V. Megaprostheses for the treatment of malignant bone tumours of the lower limbs. Int Orthop. 2006;30:452–7.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD. Endoprosthetic reconstructions: results of long-term followup of 139 patients. Clin Orthop Relat Res. 2005;438:51–9.

    Article  PubMed  Google Scholar 

  31. Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res. 2004;420:239–50.

    Google Scholar 

  32. Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 1999;81:488–94.

    Article  CAS  PubMed  Google Scholar 

  33. Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Joint Surg Am. 1998;80:636–47.

    Article  CAS  PubMed  Google Scholar 

  34. Angelini A, Drago G, Trovarelli G, Calabro T, Ruggieri P. Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution. Clin Orthop Relat Res. 2014;472:349–59.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Hillmann A, Hoffmann C, Gosheger G, Rodl R, Winkelmann W, Ozaki T. Tumors of the pelvis: complications after reconstruction. Arch Orthop Trauma Surg. 2003;123:340–4.

    Article  CAS  PubMed  Google Scholar 

  36. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours. J Bone Joint Surg Br. 2007;89:1632–7.

    Article  CAS  PubMed  Google Scholar 

  37. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br. 2007;89:521–6.

    Article  CAS  PubMed  Google Scholar 

  38. Jeys LM, Grimer RJ, Carter SR, Tillman RM, Abudu A. Post operative infection and increased survival in osteosarcoma patients: are they associated? Ann Surg Oncol. 2007;14:2887–95.

    Article  CAS  PubMed  Google Scholar 

  39. Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res. 2010;468:2885–95.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res. 2002;395:193–203.

    Google Scholar 

  41. Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–62.

    Article  PubMed  Google Scholar 

  42. Morii T, Morioka H, Ueda T, Araki N, Hashimoto N, Kawai A, et al. Functional analysis of cases of tumor endoprostheses with deep infection around the knee: a multi institutional study by the Japanese Musculoskeletal Oncology Group (JMOG). J Orthop Sci. 2013;18:605–12.

    Article  PubMed  Google Scholar 

  43. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358:876–80.

    Article  CAS  PubMed  Google Scholar 

  44. Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicente R, Ferrandiz L, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005;294:2035–42.

    Article  CAS  PubMed  Google Scholar 

  45. Kanayama M, Hashimoto T, Shigenobu K, Oha F, Togawa D. Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine. 2007;6:327–9.

    Article  PubMed  Google Scholar 

  46. Li X, Moretti VM, Ashana AO, Lackman RD. Perioperative infection rate in patients with osteosarcomas treated with resection and prosthetic reconstruction. Clin Orthop Relat Res. 2011;469:2889–94.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Tsuchiya H, Abdel Wanis ME, Sakurakichi K, Yamashiro T, Tomita K. Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg Br. 2002;84:1162–6.

    Article  CAS  PubMed  Google Scholar 

  48. Sugiura H, Yamamura S, Sato K, Katagiri H, Nishida Y, Nakashima H, et al. Remodelling and healing process of moderately heat-treated bone grafts after wide resection of bone and soft-tissue tumors. Arch Orthop Trauma Surg. 2003;123:514–20.

    Article  CAS  PubMed  Google Scholar 

  49. Puri A, Gulia A, Jambhekar N, Laskar S. The outcome of the treatment of diaphyseal primary bone sarcoma by resection, irradiation and re-implantation of the host bone: extracorporeal irradiation as an option for reconstruction in diaphyseal bone sarcomas. J Bone Joint Surg Br. 2012;94:982–8.

    Article  CAS  PubMed  Google Scholar 

  50. Holzer G, Windhager R, Kotz R. One-stage revision surgery for infected megaprostheses. J Bone Joint Surg Br. 1997;79:31–5.

    Article  CAS  PubMed  Google Scholar 

  51. Funovics PT, Hipfl C, Hofstaetter JG, Puchner S, Kotz RI, Dominkus M. Management of septic complications following modular endoprosthetic reconstruction of the proximal femur. Int Orthop. 2011;35:1437–44.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Gosheger G, Hardes J, Ahrens H, Streitburger A, Buerger H, Erren M, et al. Silver-coated megaendoprostheses in a rabbit model – an analysis of the infection rate and toxicological side effects. Biomaterials. 2004;25:5547–56.

    Article  CAS  PubMed  Google Scholar 

  53. Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br. 1994;76:178–86.

    CAS  PubMed  Google Scholar 

  54. Tsuchiya H, Shirai T, Nishida H, Murakami H, Kabata T, Yamamoto N, et al. Innovative antimicrobial coating of titanium implants with iodine. J Orthop Sci. 2012;17:595–604.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  55. Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, et al. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol. 2010;101:389–95.

    PubMed  Google Scholar 

  56. Hayashi K, Tsuchiya H, Yamamoto N, Takeuchi A, Tomita K. Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery. Int Orthop. 2008;32:63–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Kusuzaki K, Murata H, Matsubara T, Miyazaki S, Okamura A, Seto M, et al. Clinical trial of photodynamic therapy using acridine orange with/without low dose radiation as new limb salvage modality in musculoskeletal sarcomas. Anticancer Res. 2005;25:1225–35.

    CAS  PubMed  Google Scholar 

  58. Satonaka H, Kusuzaki K, Matsubara T, Shintani K, Nakamura T, Matsumine A, et al. In vivo anti-tumor activity of photodynamic therapy with intravenous administration of acridine orange, followed by illumination with high-power flash wave light in a mouse osteosarcoma model. Oncol Lett. 2010;1:69–72.

    PubMed Central  CAS  PubMed  Google Scholar 

  59. Nakamura T, Kusuzaki K, Matsubara T, Matsumine A, Murata H, Uchida A. A new limb salvage surgery in cases of high-grade soft tissue sarcoma using photodynamic surgery, followed by photo- and radio dynamic therapy with acridine orange. J Surg Oncol. 2008;97:523–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Takeshi Morii

Authors
  1. Takeshi Morii
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeshi Morii .

Editor information

Editors and Affiliations

  1. Osaka National Hospital, Osaka University, Osaka, Osaka, Japan

    Takafumi Ueda

  2. National Cancer Center Hospital, Tokyo, Tokyo, Japan

    Akira Kawai

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Japan

About this chapter

Cite this chapter

Morii, T. (2016). Management of Postoperative Infection After Limb Salvage Surgery in Osteosarcoma Patients. In: Ueda, T., Kawai, A. (eds) Osteosarcoma. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55696-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-55696-1_12

  • Published:

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55695-4

  • Online ISBN: 978-4-431-55696-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation