Outcomes of two-stage revision of endoprostheses of the lower-limb in oncology surgery: Limb-salvage

Background

Two-stage revision remains the gold standard to eradicate deep infection of endoprosthetic replacements following bone tumour removal. We aim to (1) report the infection eradication and limb-salvage rate with two-stage revision surgery and to (2) report the common causative microorganisms.

Patients and methods

A retrospective review of 44 consecutive patients who underwent two-stage revision surgery to treat periprosthetic joint infection was conducted between 1999 and 2018 ​at a tertiary orthopaedic oncology centre from prospectively collated oncology database. Patients’ mean age was 36.1 years (range 12–78 years). The sites of prosthesis were distal femur in 22 patients (50%), proximal femur in five patients (11%), proximal tibia in 16 patients (36%) and total femur with proximal tibia replacement in one patient (2%). The mean duration of follow-up was 96 months (6–251 months).

Results

Infection was eradicated in 26 patients (59%). The infection-free survival was 93% (CI 85–100%) at two years, 78% (66–92%) at five years and 61% (46–80%) at 10 years. 11 patients (25%) had amputation following failure of limb-salvage surgery. The amputation-free survival was at 100% at two years, 89% (79–100%) at five years and 73% (58–92%) at 10 years. Polymicrobial infection was reported in 8 patients (18%) and multi-drug resistance in 14 patients (32%). Coagulase-negative staphylococcus was the commonest microorganism isolated in 21 patients (48%).

Conclusion

Two-stage revision is a reliable approach to achieve limb-salvage. Infected tumour endoprostheses have a high rate of multi-drug resistance and polymicrobial infections. PJI recurrence still has a high rate of amputation.