Guidelines for Complications of Cancer Treatment Vol VIII Part B

patients had an amputation. Two other patients died frommetastatic disease with an infected endoprosthesis still in situ.In only one patient the infection could be controlled and thepatient avoided amputation of the limb. These results are worsethan those for reinfection after conventional joint replacements.This is not unexpected as the option of arthrodesis or resectionarthroplasty is not possible in patients with tumors, theimportance of controlling infection with the first revisioncannot be understated. Radiation has been linked withpersisting infection after the revision 29 . Inability to obtainadequate soft tissue cover may be another factor. Latereinfections seemed to develop after additional surgeries tothe prosthesis for causes unrelated to infection despite the useof prophylactic antibiotics and careful asepsis. It seems thatsurgical stimulus can act as a potent source of infection andall patients are made aware of this risk before every additionalsurgical procedure to their prosthesis 28 .The functional results after revision surgery for infection canbe good. Patients who have revision surgery have as good afunctional outcome as those patients with primaryendoprostheses for range of movement and everydayfunctional capacity 29 . The success rate of two-stage revisionsurgery for infected endoprostheses in patients who have nothad radiotherapy and who do not have additional surgery isonly a little worse than the success rate for infected hip andknee replacements. The same principles of treatment have beenused, but because of the extent of the surgical field it isnecessary to have appropriate soft tissue cover to allow primarywound healing at first- and second-stage surgeries. The onsetof infection in a patient with a tumor endoprosthesis is adisaster but one that can be resolved. Prevention clearly ismore desirable. The article on prophylaxis of infection dealswith these strategies. Infections of allografts and after otherprocedures are managed keeping the same principles in mind.113