DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20170434

Salvage of infected proximal tibial tumour prosthesis using vacuum assisted closure (VAC) in seven patients

Navin Balasubramanian, Sindhuja P.

Abstract


Background: Proximal tibia is the second most common site for both benign and malignant bone tumours. The treatment protocols of such tumours have seen a paradigm shift from amputation towards limb salvage. Limb salvage has been possible with resection and reconstruction using custom modular prosthesis but the risk of tumour recurrence and infection still looms large.

Methods: Here we present our series of seven patients with infected proximal tibial tumour prosthesis which were salvaged using vacuum assisted closure (VAC) dressing. The indications for surgery were recurrent giant cell tumour (4 cases), chondrosarcoma (2 cases) and osteosarcoma (one patient). The prosthesis used was the limb preservation system (LPS) [Depuy-Synthes, US]. There were 6 males (M:F 6:1) with average age of 34.23 years. The predominant organism cultured was Staph aureus. We proceeded with radical wound debridement and VAC dressing with continuous negative pressure drainage for an average of 18 days (range 12-24 days). The patients then underwent secondary suturing and delayed suture removal (18-21 days).

Results: All 7 patients were well at 8 months follow-up with no recurrent or persistent infection with good functional outcome. The average knee society score (KSS) was 73 (good).

Conclusions: We conclude that with early thorough radical debridement and with select bacteriological culture profile, VAC is a valuable tool in the salvage of infected tumour prosthesis. This may reduce the need for amputations of such infected limbs by a significant margin while still retaining good functional outcome.


Keywords


Custom modular prosthesis, Limb preservation system, Vacuum assisted closure dressing, Knee society

Full Text:

PDF

References


Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL. What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts. Clin Orthop Relat Res. 2016;474(3):669-73.

Pattanashetty OB, B B D, Pillai A, Endigeri P Dedifferentiated Chondrosarcoma of Proximal Tibia and Fibula with an Infected Ulcer: A Case Report. J Orthop Case Rep. 2016;6(2):9-12.

Kundu ZS, Gupta V, Gogna P, Sangwan SS. Partial-limb salvage after persistent infection in the distal femoral prosthesis: straight-plasty--a novel technique. J Coll Physicians Surg Pak. 2014;24(3):213-5.

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(4):605-12.

Healey JH. CORR Insights™: High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res. 2013;471(6):2028-9.

Wafa H , Grimer RJ, Reddy K, Jeys L, Abudu A, Carter SR, et al. Retrospective evaluation of the incidence of early periprosthetic infection with silver treated endoprosthesis in high risk patients : case control study . Bone Joint J. 2015:97(2):252-7.

Rocco G, Martucci N, La Rocca A, La Manna C, De Luca G, Fazioli F, et al. Post-operative local morbidity and the use of vacuum assisted closure after complex chest wall reconstruction with new and conventional materials. Ann Thoracic Surg. 2014:98(1):291-6.

Jeys L, Grimer RJ. The long term risks of infection and amputations with limb salvage surgery using endoprosthesis. Recent Results Cancer Res. 2009;179:75-84.

Hardes J, Ahrens H, Gosheger G, Nottrott M, Dieckmann R, Henricks MP, et al. Management of complications of megaprosthesis. Unfalchirurg. 2014;117(7):607-13.

Pala E, Trovaarelli G, Calabro T, Angelini A, Abati Cn, Ruggieri P. Survival of modern knee tumour prosthesis: failures, functional results and a comparative statistical analysis. Clin Orthop Relat Res. 2015;473(3):891-9.

Marvogenis AF, Pala E, Angelini A, Calabro TT, Romagnoli C, Romantini M, et al. Infected prosthesis after lower extremity bone tumour resection: Clinical outcome of 100 patients. Surg Infect (Larchmt). 2015;16(3):267-75.

Kundu ZS, Gupta V, Gogna P, Sangwan SS. Partial limb salvage after persistent infection in the distal femur prosthesis : straight plasty- a novel technique. J Coll Physicians Surg Pak. 2014;24(3):213-5.

Angelini A, Henderson E, Trovarelli G, Ruggieri P. Is there a role of knee arthrodesis with modular endoprosthesis for tumour and revision of failed endoprosthesis? Clin Orthop Relat Res. 2013;471(10):3326-35.

Pilge H, Gradl G, Von Eisenhart-Rothe R, Gollwitzer H. Incidence and outcome after infection of megaprosthesis. Hip Int. 2013;22(8):583-90.

Ji T, Guo W, Yang R, Tang X. Two stage revisons for prosthesis infection in patients with bne tumour after knee prosthetic replacement. Zhongguo Xiu Fu Chong Jian Wai KE Ze Zhi. 2012;26(1):21-5.

Marvogenis AF, Papagelopoulous PJ, Coll-Mesa L, Pala E, Guerra G, Ruggieri P. Infected tumour prosthesis. Orthopedics. 2011;32(12):991-8.

Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C. Infection following bone tumour resection and reconstruction using tumoural prosthesis- A literature review. Int Immunopathol Pharmacol. 2010;23(4):1005-13.

Fukagawa S, Matsuda S, Miura H, Okazuki K, Tashiro Y, IwamotoY. High dose antibiotic infusion for infected knee prosthesis without implant removal. J Orthop Sci. 2010;15(4):470-6.

Flint MN. Griffin AM, Bell RS, Wunder JS, Ferguson PC. Two stage revision of infected uncemented lower extremity tumour endoprosthesis. J Arthrolpasty. 2007;22(6):859-65.

Kunhe CA, Taeger G, Nast-Kolb D, Ruchholtz S. Knee arthrodesis after infected tumour megaprosthesis of the knee using an intramedullary nail for callus distraction. Lagenbecks Arch Surg. 2003;388(1):56-9.

Grimer RJ, Belthhus M, Chandrasekar C, Carter SR, Tillman RM. Two stage revision for infected endoprosthesis used in tumour surgery. Clin Orthop Relat Res. 2002;295:193-203.