Guidelines for Complications of Cancer Treatment Vol VIII Part B

An infection can have disastrous consequences; It may delaythe planned adjuvant chemotherapy and, at times, the limbmay end up with an amputation.The Treatment of InfectionTreatment of an infected tumor endoprosthesis is much liketreatment of an infected regular hip or knee replacement exceptthat after tumor resection there is a dramatically larger expanseof potentially infected tissue. The possibility of excisionarthroplasty or arthrodesis, which might be considered optionsat the hip and knee respectively, are not available because ofthe amount of bone removed at the time of the initial tumorresection. Consequences of failing to control the infection arepersistent pain, stiffness, and discharging sinuses thateventually could lead to amputation, something that rarely isrequired after infected hip or knee replacements. The optionsfor controlling infection include debridement, lavage,irrigation, and one- or two-stage revisions 16-21 .Infection at the site of a total joint arthroplasty can be classifiedinto four basic categories 22 : Type I (early postoperative), TypeII (late chronic), Type III (acute hematogenous), and Type IV(positive intraoperative cultures with clinically unapparentinfection). Acute postoperative infection occurs within 4 weeksof surgery and is initially treated with debridement withretention of the prosthesis and intravenous antibiotics. Localhigh concentration of antibiotic can be achieved by usingantibiotic impregnated cement beads. Type III or Acutehemategenous infection occurs when bacteremia causesseeding at the site of arthroplasty and is treated exactly as inType I infection. For a type IV infection, a course ofintravenous antibiotics is recommended.Late chronic infection is the most difficult to manage. Thecurrent standard of care for type II or late chronic infection is107