Guidelines for Complications of Cancer Treatment Vol VIII Part B

and facilitating reimplantation surgery. This operativetreatment decreases cost and improves patient outcomes aswell as addresses some of the disadvantages of two-stagerevision procedures in which spacers are not used. Lee et al 28also reported that one-stage treatment was not successful inany of their patients whereas a two stage revision resulted incontrol of infection in all the cases. The authors conclude thattwo stage revision should be used despite disadvantages suchas long hospitalisation, more bone loss, more disuseosteoporosis, difficulty of revision operation, and shorteningof the affected limb. They recommend that one stage revisionshould be used only for poor general condition of the patient,low-grade infection, or long delay of chemotherapy.There are two types of antibiotic-impregnated cement spacersthat are typically used in two-stage revisions of total hip andknee arthroplasties: nonarticulating (block or static andarticulating (mobile). Nonarticulating spacers allow localdelivery of a high concentration of antibiotics and at the sametime function to maintain joint space for future revisionprocedures. Their disadvantages include a limited range ofmotion of the joint after the operation, resulting in quadricepsor abductor shortening, scar formation, and bone loss. Forlarge Tumor defects these are chosen due to the difficulty infabricating articulating spacers. Grimer et al 29 reported theirexperience with thirty-four patients with infected massiveendoprostheses treated with two-stage revision procedureswith an antibiotic impregnated cement spacer constructed withtwo cement gun liners and a Kuntscher nail. This nonarticulatingspacer provided temporary stability and alsoallowed a high dose of local antibiotic concentration. Theoverall success rate for controlling infection was 91% at 1year and 74% at 5 years with six patients requiring anamputation.109