Infected Prostheses after Lower-Extremity Bone Tumor Resection: Clinical Outcomes of 100 Patients.

BACKGROUND: Infection of megaprostheses after bone tumor resection is a major concern; management is challenging. This study evaluated the survivability from such infections, the microbial isolates, treatment tactics, and outcome of megaprosthesis reconstructions. MATERIALS AND METHODS: We studied 1,161 patients retrospectively who underwent megaprosthesis reconstruction for limb salvage after a sarcoma from 1983 to 2010. The mean followup was 9 y (range 3-20 y). We evaluated the overall survival of the megaprosthesis reconstructions in patients with infection and the survival with respect to the type of megaprosthesis, site of reconstruction, cemented or cementless fixation, type of tumor, adjuvant treatments, microbial isolate(s), treatment tactics, and outcome. RESULTS: The incidence of infection was 8.6%. The most common microbial isolate was Staphylococcus epidermidis (47%). Overall survival with definitive management of infection was 88% at 10 y and 84% at 20 y. Survival was higher for cementless reconstructions and not different with respect to the type of megaprosthesis, site of reconstruction, or adjuvant therapy. Infections resolved completely with one- or two-stage surgery in 75% of patients. The rate of amputation because of infection was 21%. CONCLUSIONS: Megaprosthesis reconstructions may be infected in 8.6% of cases. Infections more commonly occur late, caused usually by S. epidermidis. The survival rate is higher with cementless megaprosthesis reconstructions and no different with respect to the type of tumor or megaprosthesis or the adjuvant treatments. One-stage revision is effective for acute post-operative infections; however, two-stage revision surgery is necessary for early and late infections. The rate of amputation because of occurrence or persistence of megaprosthesis infection is 21%.

Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution.

BACKGROUND: Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. QUESTIONS/PURPOSES: We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. METHODS: From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection. Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. RESULTS: A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection. Despite surgical débridements and antibiotics, 16 patients (46%) had the implant removed and five (9%) underwent external hemipelvectomy (four owing to infection and one as a result of persistent infection and local recurrence). CONCLUSIONS: Infection is a common complication of pelvic resection for bone tumors. Reconstruction after resection is associated with an increased risk of infection compared with resection alone, without significant difference in percentage between allograft and metallic prosthesis. When infection occurs, it requires removal of the implant in nearly half of the patients who have this complication develop, and external hemipelvectomy sometimes is needed to eradicate the infection.

Survival analysis of patients with chondrosarcomas of the pelvis.

BACKGROUND: Studies for patients with pelvic chondrosarcomas are limited. This study determines the outcome of patients with pelvic chondrosarcomas, and whether there is any association with tumors' grade, type, stage, margins and pelvic location. MATERIALS AND METHODS: We retrospectively studied 215 patients with pelvic chondrosarcomas. All patients had biopsy and histological diagnosis of their tumors followed by limb salvage or amputation. We staged patients using the Musculoskeletal Tumor Society system. We performed a univariate and multivariate analysis of the survival to death, local recurrence and metastasis with respect to grade, type (central vs. peripheral), stage, margins, and pelvic location, and the survival to death of patients with and without local recurrence. RESULTS: Grade was the most important univariate and multivariate predictor of the survival of the patients. Dedifferentiation was associated with significantly lower overall survival. Peripheral chondrosarcomas predicted survival only in the univariate analysis. Surgical margins predicted local recurrence only in the multivariate analysis. Periacetabular location was associated with lower survival to death and local recurrence. The occurrence of local recurrence compromises the overall survival. CONCLUSION: Grade was the most important predictor of the overall survival of patients with chondrosarcomas of the pelvis.

Post-tsunami primary Scedosporium apiospermum osteomyelitis of the knee in an immunocompetent patient.

Scedosporium apiospermum is a filamentous fungus present in soil and polluted waters that may cause infection by direct inoculation. Osteomyelitis represents a challenge both for diagnosis and treatment. We report a case of post-tsunami primary S. apiospermum osteomyelitis of the knee in an immunocompetent patient.

Hibernomas: clinicopathological features, diagnosis, and treatment of 17 cases.

Hibernomas are rare benign adipose tumors composed of brown fat cells with granular, multivacuolated cytoplasm admixed with white adipose tissue. They account for 1.6% of benign lipomatous tumors and approximately 1.1% of all adipocytic tumors. They are more common in the third and fourth decades of life. The most common location is the thigh, followed by the shoulder, back, and head and neck. Four histological types have been reported; abundant vascularity is characteristic, and atypias are rare. The treatment of choice for hibernomas is complete surgical excision. Metastases or malignant transformation have not been reported.This article presents a series of 17 patients with hibernomas diagnosed and treated at our institution from January 1986 to December 2009. Six men and 11 women (M:F, 1:2) had a mean age of 38 years (range, 10 months to 64 years). All patients underwent surgical treatment; 14 patients had marginal and 3 had wide excision. Adjuvants such as radiation therapy, chemotherapy, or embolization were not administered for any patient. The most common symptom was a painless palpable mass, followed by a tender or painful mass; in 2 patients, the tumor was an incidental finding. The duration of symptoms ranged from 1 month to 10 years (mean, 27 months). The most common location was the thigh, followed by the buttock, scapula, and neck. The most common histological variant was the typical variant followed by the lipoma-like variant. At a mean follow-up of 5 years (range, 1-9 years), local recurrences were not observed.