Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-02-01 DOI:10.1302/0301-620X.107B2.BJJ-2024-0562.R2

Andrea Sambri, Domenico A Campanacci, Elisa Pala, Maria A Smolle, Davide M Donati, Michiel A J van de Sande, Oleg Vyrva, Andreas Leithner, Lee Jeys, Pietro Ruggieri, Massimiliano De Paolis, Michele Fiore, Marta Bortoli, Alessandro Bruschi, Elisabetta Neri, Diogo Catelas, Vania Oliveira, Marko Bergovec, Korhan Özkan, Aykut Çelik, Erhan Okay, Luca Cevolani, Robert V der Wal, Richard Evenhuis, Minna Laitinen, Roman Malik, Andreas Krieg, Paul Jutte, Min W Joo, Tariq Azamgarhi, Craig Gerrand, Rob Pollock, Jasprit Kaur, Jonathan Stevenson, Hartej Sur, Guy Morris

{"title":"Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study.","authors":"Andrea Sambri, Domenico A Campanacci, Elisa Pala, Maria A Smolle, Davide M Donati, Michiel A J van de Sande, Oleg Vyrva, Andreas Leithner, Lee Jeys, Pietro Ruggieri, Massimiliano De Paolis, Michele Fiore, Marta Bortoli, Alessandro Bruschi, Elisabetta Neri, Diogo Catelas, Vania Oliveira, Marko Bergovec, Korhan Özkan, Aykut Çelik, Erhan Okay, Luca Cevolani, Robert V der Wal, Richard Evenhuis, Minna Laitinen, Roman Malik, Andreas Krieg, Paul Jutte, Min W Joo, Tariq Azamgarhi, Craig Gerrand, Rob Pollock, Jasprit Kaur, Jonathan Stevenson, Hartej Sur, Guy Morris","doi":"10.1302/0301-620X.107B2.BJJ-2024-0562.R2","DOIUrl":null,"url":null,"abstract":"Aims: The aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.Methods: A retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.Results: A total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).Conclusion: This study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"253-260"},"PeriodicalIF":4.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0562.R2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Aims: The aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.

Methods: A retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.

Results: A total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).

Conclusion: This study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.

查看原文本刊更多论文

肿瘤巨型假体感染的两阶段修复：一项多中心EMSOS研究。

目的：本研究的目的是评估骨肿瘤切除术后植入的感染巨型假体（MPR）两期翻修后患者再感染的发生率。方法：2010年1月至2020年12月，对来自16个骨肉瘤中心的186例患者进行回顾性研究。肿瘤诊断时的中位年龄为26岁（IQR为17 ~ 33岁）；女性69例（37.1%），男性117例（62.9%）。结果：共纳入186例慢性MPR感染患者。中位随访68个月（IQR 31 ~ 105）。MPR最典型的部位是股骨远端93例（50.0%）和胫骨近端53例（28.5%）。多微生物感染34例（18.3%）。最常见的分离病原菌为葡萄球菌。分离出难治性致病菌50例（26.9%）。5年感染复发率为39.1%，10年感染复发率为50.0%。与非DTT感染相比，DTT PJI感染的IR率更高（p = 0.019）。多微生物感染的复发率也较高（p = 0.046）。结论：本研究表明，对感染的MPR进行两阶段翻修并最终用MPR再植是成功的，但外科医生必须意识到与感染的传统种植体相比，复发率很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

期刊介绍： We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.