Deep infections after endoprosthetic replacement operations in orthopedic oncology patients

Amreeta Dhanoa, Vivek Ajit Singh, Hassan Elbahri

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    Abstract

    Numerous studies have described various complications after endoprosthetic reconstructive operations. However, there are limited reports that focus specifically on deep infections (e.g., deep incisional surgical site infections), which remain one of the most dreaded complications of these operations, with rates ranging from 10 to 17 . Thus, this study was undertaken to determine the deep infection rates and to analyze possible risk factors, clinico-pathologic characteristics, and treatment modalities of endoprosthetic infections. Methods: We reviewed retrospectively the records of 105 consecutive patients who underwent endoprosthesis replacements from January 2007 to September 2011, with a minimal follow-up period of 32mo. Comparison was made between patients with and without endoprosthetic infections. Results: Thirteen of the 150 patients (12.38 ) who underwent endoprosthetic operations developed deep infections. Ninety-seven (92.4 ) patients presented with a primary bone/soft tissue tumor, 5 (4.8 ) with bone metastasis, and 3 (2.9 ) with non-tumor conditions. Distal femoral was the most common implant location (42 ). The majority of the infections (6/13) occurred within 3mo post-operation. An elevated C-reactive protein concentration or erythrocyte sedimentation rate were present consistently in all patients at time of diagnosis, whereas clinical presentations and leukocytosis were inconsistent in determining infection. Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were the most common organisms isolated, with high numbers demonstrating methicillin-resistance. Overall, multi-drug resistance was noted in 52.6 of the isolated strains. Four risk factors were associated independently with deep infection by multivariable analysis (p
    Original languageEnglish
    Pages (from-to)323 - 332
    Number of pages10
    JournalSurgical Infections
    Volume16
    Issue number3
    DOIs
    Publication statusPublished - 2015

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