Closed-Incision Negative-Pressure Wound Therapy in Proximal and Distal Femur Megaprosthetic Reconstructions after Bone Tumor Resections

Abstract

Objective Surgical management for bone tumors is aggressive in nature and frequently followed by wound-related complications (WRCs). To minimize these events, different strategies have been employed, with closed-incision negative-pressure wound therapy (ciNPWT) emerging as a potential adjuvant. With this study we intend to assess the impact of this technique in minimizing WRCs in patients with proximal and distal femur tumors treated with megaprosthesis.

Methods This was an observational retrospective study including 41 participants diagnosed with proximal or distal femur tumors treated with wide resection and reconstruction using a megaprosthesis. Patients were divided into two groups based on the postoperative surgical dressing applied: the vacuum-assisted closure group (VAC) received ciNPWT; and the non-VAC group that received conventional dressings. Data regarding postoperative WRCs and other potential variables of interest were recorded. Statistical analysis was carried out using the IBM SPSS Statistics, version 24.0.

Results There were 20 patients included in the VAC and 21 in the non-VAC group. The majority of patients presented no complications and there were no differences between groups in terms of WRCs, including infection. Nonetheless, wound dehiscence and persistent fluid leakage had a positive correlation with the diagnosis of infection, which all together presented correlation with the need for surgical revision.

Conclusion Despite the absence of statistical significance, ciNPWT seems to help minimize wound dehiscence, persistent wound leakage and surgical site infections in patients with proximal and distal femur bone tumors treated with megaprosthesis. Also, wound dehiscence and persistent wound leakage correlate well with surgical site infection, and those three parameters correlate with the need for surgical revision.

Keywords

negative-pressure wound therapy - neoplasms - prosthesis - sarcoma - surgical wound infection

Authors' Contributions

JSB contributed to study conception and design, data analysis and interpretation, writing, and tables organization. All the remaining authors also made substantial contributions to study conception, data analysis, and revision.

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private or non-profit sectors to conduct the present study.

Work developed at the Department of Orthopedics and Trauma, Hospital de Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.

Publication History

Received: 07 November 2024

Accepted: 09 January 2025

Article published online:
28 April 2025

• Referências

• 1 Alvand A, Grammatopoulos G, de Vos F. et al. Clinical Outcome of Massive Endoprostheses Used for Managing Periprosthetic Joint Infections of the Hip and Knee. J Arthroplasty 2018; 33 (03) 829-834
• 2 Grammatopoulos G, Alvand A, Martin H, Whitwell D, Taylor A, Gibbons CL. Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Joint J 2016; 98-B (11) 1463-1470
• 3 Smolle MA, Andreou D, Tunn PU, Leithner A. Advances in tumour endoprostheses: a systematic review. EFORT Open Rev 2019; 4 (07) 445-459
• 4 Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 2006; 450 (450) 164-171
• 5 Parvizi J, Tarity TD, Slenker N. et al. Proximal femoral replacement in patients with non-neoplastic conditions. J Bone Joint Surg Am 2007; 89 (05) 1036-1043
• 6 Dieckmann R, Schmidt-Braekling T, Gosheger G, Theil C, Hardes J, Moellenbeck B. Two stage revision with a proximal femur replacement. BMC Musculoskelet Disord 2019; 20 (01) 58
• 7 Grimer RJ, Aydin BK, Wafa H. et al. Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone. Bone Joint J 2016; 98-B [phone]
• 8 Thornley P, Vicente M, MacDonald A, Evaniew N, Ghert M, Velez R. Causes and Frequencies of Reoperations After Endoprosthetic Reconstructions for Extremity Tumor Surgery: A Systematic Review. Clin Orthop Relat Res 2019; 477 (04) 894-902
• 9 Theil C, Röder J, Gosheger G. et al. What is the Likelihood That Tumor Endoprostheses Will Experience a Second Complication After First Revision in Patients With Primary Malignant Bone Tumors And What Are Potential Risk Factors?. Clin Orthop Relat Res 2019; 477 (12) 2705-2714
• 10 Jeys L, Grimer R. The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res 2009; 179: 75-84
• 11 Jeys LM, Grimer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 2003; 27 (03) 160-163
• 12 Morii T, Yabe H, Morioka H. et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci 2010; 15 (03) 331-339
• 13 Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 2005; 87 (04) 842-849
• 14 Ghert M, Schneider P, Guyatt G. et al; Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Investigators. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial. JAMA Oncol 2022; 8 (03) 345-353
• 15 Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res 2013; 471 (06) 2017-2027
• 16 Soares do Brito J, Esperança Martins M, Goes R. et al. Closed-incision negative-pressure wound therapy (ciNPWT) to minimize wound-related complications in lower limb reconstruction after bone tumor resection: preliminary proof-of-concept study. Eur J Orthop Surg Traumatol 2023; 33 (07) 2895-2902
• 17 Morgan T, Page T. The effectiveness of prophylactic closed incision negative pressure wound therapy compared to conventional dressings in the prevention of periprosthetic joint infection post hip and knee revision arthroplasty surgery: A systematic review. Int J Orthop Trauma Nurs 2024; 53: 101048
• 18 Chan PK, Fung WC, Lam KH. et al. The application of close incisional negative pressure wound therapy in revision arthroplasty among asian patients: a comparative study. Arthroplasty 2021; 3 (01) 38
• 19 Henderson ER, O'Connor MI, Ruggieri P. et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions. Bone Joint J 2014; 96-B (11) 1436-1440
• 20 Ailaney N, Johns WL, Golladay GJ, Strong B, Kalore NV. Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2021; 36 (07) 2402-2411
• 21 Newman JM, Siqueira MBP, Klika AK, Molloy RM, Barsoum WK, Higuera CA. Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection: A Prospective, Randomized Clinical Trial. J Arthroplasty 2019; 34 (03) 554-559.e1
• 22 Kim JH, Kim HJ, Lee DH. Comparison of the Efficacy Between Closed Incisional Negative-Pressure Wound Therapy and Conventional Wound Management After Total Hip and Knee Arthroplasties: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34 (11) 2804-2814
• 23 Kim JH, Lee DH. Are high-risk patient and revision arthroplasty effective indications for closed-incisional negative-pressure wound therapy after total hip or knee arthroplasty? A systematic review and meta-analysis. Int Wound J 2020; 17 (05) 1310-1322
• 24 LiBrizzi CL, Sabharwal S, Forsberg JA. et al; PARITY Investigators. Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Infecção do sítio cirúrgicos?: A PARITY Trial Secondary Analysis. J Bone Joint Surg Am 2023; 105 (Suppl. 01) 34-40
• 25 Baptista AM, Camargo AFF, Caiero MT, Torres JSCS, Narciso JH, Silva MRD. Role of incisional vacuum therapy in endoprosthetic bone reconstruction surgery. Acta Ortop Bras 2023; 31 (04) e260330
• 26 Hyldig N, Birke-Sorensen H, Kruse M. et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg 2016; 103 (05) 477-486
• 27 Nam D, Sershon RA, Levine BR, Della Valle CJ. The use of closed incision negative-pressure wound therapy in orthopaedic surgery. J Am Acad Orthop Surg 2018; 26 (09) 295-302
• 28 Langit MB, Miwa S, Yamamoto N. et al. Risk Factors for Postoperative Deep Infection After Malignant Bone Tumor Surgery of the Extremities. Anticancer Res 2020; 40 (06) 3551-3557
• 29 Shields DW, Razii N, Doonan J, Mahendra A, Gupta S. Closed incision negative pressure wound therapy versus conventional dressings following soft-tissue sarcoma excision: a prospective, randomized controlled trial. Bone Jt Open 2021; 2 (12) 1049-1056
• 30 Dadras M, Ufton D, Sogorski A. et al. Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial. Plast Reconstr Surg 2022; 149 (05) 972e-980e
• 31 Irwin TJ, Orgill D. Closed Incision Negative Pressure Wound Therapy After Resection of Large, Radiated, Soft Tissue Sarcomas. Cureus 2020; 12 (05) e8055