Open Access Open Badges Research article

Deep infection in tumor endoprosthesis around the knee: a multi-institutional study by the Japanese musculoskeletal oncology group

Takeshi Morii1*, Hideo Morioka2, Takafumi Ueda3, Nobuhito Araki4, Nobuyuki Hashimoto5, Akira Kawai6, Kazuo Mochizuki1 and Shoichi Ichimura1

Author Affiliations

1 Department of Orthopaedic Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan

2 Department of Orthopaedic Surgery, Keio University, Tokyo, Japan

3 Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan

4 Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

5 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

6 Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan

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BMC Musculoskeletal Disorders 2013, 14:51  doi:10.1186/1471-2474-14-51

Published: 31 January 2013



The incidence of endoprosthesis failure has been well studied, but few studies have described the clinical characteristics of deep infection in tumor prostheses. This study aimed to analyze the characteristics of deep infection in tumor endoprostheses around the knee.


We analyzed clinical data of 57 patients with deep infections involving tumor endoprostheses around the knee enrolled from the Japanese Musculoskeletal Oncology Group. Profile of clinical presentation including time between surgery and infection, initial symptoms/blood tests and microbial cultures was evaluated. In addition pre-, intra-, and postoperative clinical factors influencing clinical presentation and treatment outcomes of infections were analyzed.


Mean interval between the initial operation and diagnosis was 13 months, and mean time required for infection control was 12 months. The most common pathogen was Staphylococcus. Infection control rates were significantly higher when prostheses were removed rather than salvaged. Ten-year prosthesis survival and limb salvage rates were 41.6% and 75.6%, respectively. Analysis of underlying clinical factors suggested that soft-tissue condition significantly influenced the duration of the infection control period and likelihood of limb salvage.


Infection control is a prolonged process. Deep infection frequently results in amputation or prosthesis loss. Intensive analysis of clinical characteristics may aid infection control.

Infection; Bone tumor; Endoprosthesis; Knee