Purpose:Periprosthetic joint infection (PJI) is a devastating complication following limb salvage surgery with tumor megaprosthetic reconstruction, leading to high morbidity and complex management. Despite advancements in prosthesis design and materials, infection rates are notably higher than in conventional arthroplasty. This narrative review synthesizes current evidence on the etiology, diagnosis, and management of PJIs in this unique setting.Methods:We conducted narrative review of literature from PubMed and Embase using keywords related to PJIs and tumor megaprostheses, aiming to summarize risk factors, diagnostic criteria, pathogen profiles, and treatment outcomes.Results:Key findings indicate that the risk of PJI is multifactorial, involving patient-related, disease-related, and treatment-related factors. Diagnosis relies on a combination of clinical presentation, serological markers, imaging, and microbiological studies, though established criteria for conventional PJI may require adaptation for tumor cases. Treatment strategies include irrigation and debridement (I&D), debridement, antibiotics, implant retention with modular component exchange (DAIR), one-stage or two-stage revision, and amputation. Success rates vary, and optimal management requires a multidisciplinary, individualized approach. However, two-stage revision is considered the gold standard for chronic PJIs.Conclusions:PJIs after tumor megaprosthetic reconstruction presents distinct challenges. Management requires a multidisciplinary, individualized approach. Future research should focus on validated diagnostic criteria for this population, novel anti-biofilm strategies, and standardized treatment protocols.
目的：假体周围感染是肿瘤假体重建保肢术后一种严重的并发症，其发病率高且治疗复杂。尽管假体设计和材料已有显著进步，感染率仍明显高于常规关节置换术。本文通过叙述性综述，整合了该特殊背景下假体周围感染的病因学、诊断与治疗的最新证据。
方法：我们在PubMed和Embase数据库中采用与假体周围感染及肿瘤假体相关的关键词进行文献综述，旨在总结危险因素、诊断标准、病原体特征及治疗结果。
结果：主要发现表明假体周围感染的风险具有多因素性，涉及患者相关、疾病相关及治疗相关因素。诊断需结合临床表现、血清学标志物、影像学及微生物学检查，但常规假体周围感染的既定诊断标准可能需针对肿瘤病例进行调整。治疗策略包括冲洗清创术、清创联合抗生素治疗及假体模块更换保留术、一期或二期翻修术以及截肢术。治疗成功率存在差异，最佳管理需多学科协作的个体化方案，而二期翻修术被认为是慢性假体周围感染的金标准治疗。
结论：肿瘤假体重建术后假体周围感染具有独特的临床挑战。其治疗需采取多学科协作的个体化策略。未来研究应致力于建立针对该人群的验证性诊断标准、开发新型抗生物膜策略以及制定标准化治疗方案。
肿瘤(癌症)患者之家