Treatment of Periprosthetic Joint Infection After Tumor Megaprosthetic Reconstruction: A Narrative Review
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis manuscript provides a comprehensive and well-structured narrative review on periprosthetic joint infection (PJI) following tumor-type joint prosthetic replacement. The topic is clinically important and underrepresented in the literature compared to conventional arthroplasty-related PJI. The authors successfully summarize risk factors, diagnostic challenges, pathogen profiles, and treatment strategies specific to oncologic megaprostheses. Overall, the manuscript is suitable for publication after minor to moderate revision, primarily to improve clarity, consistency, and depth in certain sections.
Specific comments:
- There are some repetitive statements regarding infection rates and chemotherapy-related immunosuppression that could be condensed.
- Minor language polishing is recommended (grammar, article usage, sentence length).
- The manuscript lists Author Contributions twice—this should be corrected.
- Consider standardizing terminology (e.g., “tumor prosthesis,” “tumor-type prosthesis,” “megaprosthesis”).
- Although this is a narrative review, the literature selection process could be described more transparently. (Specify approximate number of studies reviewees; Clarify inclusion/exclusion rationale; Briefly justify why a systematic approach was not feasible)
- The limitations of applying MSIS/Parvizi criteria to tumor prostheses are acknowledged but not deeply analyzed.
- Failure and success rates are mentioned but scattered across sections.
- Add a summary table comparing outcomes (DAIR vs one-stage vs two-stage) specifically for tumor prostheses.
- Future directions section could be expanded. Expand this section with clearer translational perspectives and ongoing clinical trials if available.
Author Response
Dear Reviewer,
Thanks a lot for your letter and for the reviewers’ comments regarding our manuscript. We have studied the comments carefully and have made correction which we hope meet with approval.
The main corrections in the paper and the responses to reviewers’ comments are as follows:
Response to Reviewer
Comment 1: There are some repetitive statements regarding infection rates and chemotherapy-related immunosuppression that could be condensed. Minor language polishing is recommended (grammar, article usage, sentence length).
Response: Thank you for this suggestion. We have thoroughly revised the manuscript to eliminate redundant content, particularly in the Introduction and “Etiology and Risk Factors” sections. The text has been condensed and language has been polished throughout for better clarity and readability.
Comment 2: The manuscript lists Author Contributions twice—this should be corrected.
Response: We have removed the duplicate “Author Contributions” statement from the Abstract section and retained only the complete statement in the Declarations section at the end of the manuscript.
Comment 3: Consider standardizing terminology (e.g., “tumor prosthesis,” “tumor-type prosthesis,” “megaprosthesis”).
Response: We have standardized the terminology to “tumor megaprosthesis” or “megaprosthesis” throughout the manuscript, except where direct quotations from cited literature require the original wording.
Comment 4: Although this is a narrative review, the literature selection process could be described more transparently. (Specify approximate number of studies reviewed; Clarify inclusion/exclusion rationale; Briefly justify why a systematic approach was not feasible)
Response: We have expanded the Methods section to include:
A clear description of the search strategy, databases, and date range.
Explicit inclusion and exclusion criteria.
The approximate number of articles reviewed (85 studies).
A brief justification for the narrative approach, citing the heterogeneity of study designs and outcomes.
Comment 5: The limitations of applying MSIS/Parvizi criteria to tumor prostheses are acknowledged but not deeply analyzed.
Response: We have added a dedicated subsection 4.1 “Limitations of Conventional Criteria in Tumor Settings” under the Diagnosis section, discussing how chemotherapy, larger implants, and altered anatomy affect the interpretation of standard biomarkers.
Comment 6: Failure and success rates are mentioned but scattered across sections. Add a summary table comparing outcomes (DAIR vs one-stage vs two-stage) specifically for tumor prostheses.
Response: We have consolidated outcome data into Table 1: “Treatment Modalities for PJI in Tumor Megaprostheses: Indications and Outcomes,” which provides a clear, side-by-side comparison of DAIR, one-stage, two-stage revision, and amputation, including key indications and reported success rates.
Comment 7: Future directions section could be expanded. Expand this section with clearer translational perspectives and ongoing clinical trials if available.
Response: We have significantly expanded the “Future Directions and Conclusions” section to highlight specific research priorities such as validated diagnostic criteria, optimized antibiotic protocols, antimicrobial coatings, and the need for randomized trials. We also reference the ongoing PARITY trial where relevant.
Reviewer 2 Report
Comments and Suggestions for AuthorsIn this study the authors address an important topic about (Treatment of periprosthetic infection after tumor-type joint prosthetic replacement: A narrative review ). Despite this some points should be addressed before publishing.
Title, well written and informative.
Abstract well written and followed standard abstract writing.
Introduction, please add more details about PJI. epidemiology, risk factors, biomarkers, and therapeutic options. Moreover add information about common microbial causes PJI. Please add the study rationale.
Methods, please add inclusion and inclusion criteria.
This lack illustrative figures and tables, please add table indicating biomarkers of PJI.
Please , add table indicating PJI therapeutic modilities.
Please, add figures indicating the causes and consequences of PJI.
Please, add discussion section, as well discuss the study novelty and limitations.
Please check the manuscript for misuse of acronyms and long sentences or paragraphs without references citation.
Please check the references list for 2025, 2026 citation dated.
Comments on the Quality of English Language
Please check the manuscript for minor grammar errors and syntax.
Author Response
Dear Editors and Reviewers,
Thanks a lot for your letter and for the reviewers’ comments regarding our manuscript. We have studied the comments carefully and have made correction which we hope meet with approval.
The main corrections in the paper and the responses to reviewers’ comments are as follows:
Response to Reviewer 2
In this study the authors address an important topic about (Treatment of periprosthetic infection after tumor-type joint prosthetic replacement: A narrative review ). Despite this some points should be addressed before publishing.
Title, well written and informative.
Abstract well written and followed standard abstract writing.
Comment 1: Introduction, please add more details about PJI. epidemiology, risk factors, biomarkers, and therapeutic options. Moreover add information about common microbial causes PJI. Please add the study rationale.
Response: We have expanded the Introduction to include:
More detailed epidemiology comparing infection rates in tumor vs. conventional arthroplasty.
A brief overview of common pathogens.
A clearer statement of the review’s rationale and specific aims.
Comment 2: Methods, please add inclusion and exclusion criteria.
Response: As noted above, we have added detailed inclusion/exclusion criteria to the Methods section.
Comment 3: This lack illustrative figures and tables, please add table indicating biomarkers of PJI.
Response: We have added Table 1 about this information.
Comment 4: Please , add table indicating PJI therapeutic modilities.
Response: We have added Table 2 about this information.
Comment 5: Please, add figures indicating the causes and consequences of PJI.
Response: Thanks for your suggestion. We did not ues figures to show this information due to the information was stated in Section 3.1 and 3.2.
Commet 6: Please add a discussion section, as well as discuss the study novelty and limitations.
Response: We have restructured the latter part of the manuscript into two distinct sections:
- Discussion: This section now synthesizes key findings, discusses the novelty and clinical implications of our review, and explicitly states the study limitations (narrative design, heterogeneous evidence). Future Directions and Conclusions: This separate section outlines translational research priorities.
Comment 7: Please check the manuscript for misuse of acronyms and long sentences or paragraphs without references citation.
Response: We have carefully edited the manuscript to:
Define all acronyms upon first use.
Break down long sentences and paragraphs.
Ensure every key statement is supported by appropriate citations.
Comment 8: Please check the references list for 2025, 2026 citation dated.
Response: We have thoroughly reviewed the reference list and confirmed that all citations are to published works from 2025 or earlier.
Additional Improvements
We have performed comprehensive language editing to enhance fluency and adhere to academic writing standards.
All tables are now cited and described in the text.
The overall flow of the manuscript has been improved for better logical progression.
We believe these revisions have substantially strengthened the manuscript and addressed all concerns raised by the reviewers. We are grateful for the insightful feedback and hope that the revised version is now suitable for publication.
Thank you for your time and consideration.
