Guidelines for Complications of Cancer Treatment Vol VIII Part B

increased mechanical constraints placed directly within theendoprosthesis, thus raising the local stress transferred to theprosthesis, and to the prosthesis-bone interface, (4) poorimmunological, hematological, or nutritional status resultingfrom chronic oncologic diseases or chemotherapy. It in turnaccelerates the wear processes of the components, inducesthe wear particulate disease and local osteolysis, as well as tocause the aseptic loosening eventually. The commoncomplications include wound necrosis, aseptic loosening,fatigue fracture, local osteolysis, joint contracture,dislodgement/dislocation, nerve or vascular injury, rotationaldeformity, leg length discrepancy, infection, periprosthecticfracture, etc. Some patients need revision of the construct and,at times, an amputation. Early detection and early correctionof minor complications has an important role of preventingthe major complications, thus reduces the necessity ofreoperation, and at times, amputation. We will review in detailthe literature and evidence related to infection and vascularcomplications. Guidelines based on the published evidence isprovided related to infection and vascular complications.1. IntroductionThe advent of adjuvant chemotherapy, imaging techniquesand surgical techniques improved the survival rate andfunctional outcomes of the patients with malignant bone tumorsaround the knee in the recent three decades. Takingosteosarcoma as an example, new generation neoadjuvantchemotherapy reduces lung metastasis, improves the 5-yearsurvival rate, decreases the tumor size, and permits a closersurgical resection margin for the malignant bone tumor.Different kinds of limb salvage procedures provide betteroverall functional outcomes of extremity and bettert body imageas compared to those with amputees without the expense ofincreased local recurrence and shortening the survival time.The principle of limb salvage surgery is to widely resect the98