Peri-Prosthetic Infection in the Orthopedic Tumor Patient

Abstract

Background: Infection complicates traditional joint reconstruction prostheses in up to 7% of cases, with even higher rates in oncologic cases. Questions / Purposes: The authors ask if prosthetic infection in bone tumor patients is associated with any epidemiologic, treatment, or outcome variables that could influence management of these difficult conditions. Patients and Methods: Authors retrospectively reviewed 329 consecutive bone tumor (malignant and benign) patients treated with hip or knee tumor resection and subsequent joint reconstruction, comparing infected and non-infected cases. Patients were followed for a mean of 34 months. Results: Of lower extremity tumor reconstructions, 13.1% developed periprosthetic infection, with the knee significantly more involved than the hip (20.5% vs 6.1%). The most common organism cultured was Staphylococcus aureus (33%). The diagnosis of sarcoma was associated with a higher infection rate, and infections were associated with a two-fold increase in number of total surgeries. Adjuvant radiation alone and chemotherapy alone (but not in combination) was associated with statistically increased infection rates. Debridement with fixed implant retention achieved a 70% infection remission rate, as opposed to 62% with two-staged treatment, and 100% with amputation. The implants tended to survive longer than the patients. Conclusions: Infection complicates lower extremity prosthetic joint reconstructions in tumor patients more frequently than in non-tumor arthroplasty cases, with eradication rates lower than that of non-tumor patients. Periprosthetic infection correlates with radiation and chemotherapy administration, as well as an overall increase in revision surgery. Single stage debridement procedures result in infection remission rates comparable to two-stage reconstructions. Level of Evidence Level III, Retrospective comparative study.