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Evenhuis RE, van de Sande MAJ, Fiocco M, Broekhuis D, Bus MPA. LUMiC Endoprosthetic Reconstruction of Periacetabular Tumor Defects: A Multicenter Follow-up Study. J Bone Joint Surg Am 2024:00004623-990000000-01104. [PMID: 38781319 DOI: 10.2106/jbjs.23.01082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND We previously reported promising early results for periacetabular tumor reconstructions using the LUMiC prosthesis. The current study evaluates mid-term complications, revision rates, cumulative incidence of implant revision, and risk factors for complications in a multicenter cohort. METHODS We assessed patients in whom a tumor defect after type P1b+2, P2, P2+3, or P1b+2+3 internal hemipelvectomy was reconstructed with a LUMiC prosthesis during the period of 2008 to 2022. Complications were reported according to the Henderson classification. Competing risks models were used to estimate the cumulative incidence of implant revision for mechanical and nonmechanical reasons, and reoperations for any complication. Cox models were used to study the effect of risk factors on dislocation and infection. RESULTS One hundred and sixty-six patients (median follow-up, 4.2 years [interquartile range, 2.6 to 7.6 years]) were included. A total of 114 (69%) were treated for a primary malignant tumor, 46 (28%) for metastatic carcinoma, 5 (3%) for a benign aggressive lesion, and 1 (1%) for another reason. One hundred and sixty-five reoperations were performed in 82 (49%) of the patients; 104 (63%) of the reoperations were within 6 months. Thirty-two (19%) of 166 implants were revised: 13 (8%) for mechanical reasons, mainly dislocation (n = 5, 3%), and 19 (11%) for nonmechanical reasons, mainly periprosthetic joint infection (PJI) (n = 15, 9%). The cumulative incidences of revision for mechanical reasons and PJI (Henderson 1 to 4) at 2, 5, and 10 years were 11% (95% confidence interval [CI], 7% to 17%), 18% (12% to 25%), and 24% (16% to 33%), respectively. Previous surgery at the same site was associated with an increased dislocation risk (cause-specific hazard ratio [HRCS], 3.0 [95% CI, 1.5 to 6.4]; p < 0.01), and resections involving the P3 region were associated with an increased infection risk (HRCS, 2.5 [95% CI, 1.4 to 4.7]; p < 0.01). CONCLUSIONS Despite a substantial reoperation risk, the LUMiC prosthesis demonstrated its durability in the mid-term, with a low mechanical revision rate and most patients retaining their primary implant. Most complications occur in the first postoperative months. Patients with previous surgery at the same site had an increased dislocation risk and might benefit from more conservative rehabilitation and aftercare. Measures should be aimed at reducing the PJI risk, especially in resections involving the P3 region. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Richard E Evenhuis
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A J van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Center for Pediatric Oncology, Prinses Maxima Center, Utrecht, The Netherlands
| | - Marta Fiocco
- Center for Pediatric Oncology, Prinses Maxima Center, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
- Medical Statistics, Department of Biomedical Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michaël P A Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Gonzalez MR, Pretell-Mazzini J, Lozano-Calderon SA. Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses-A Review of the Literature. Antibiotics (Basel) 2023; 13:25. [PMID: 38247584 PMCID: PMC10812472 DOI: 10.3390/antibiotics13010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
Prosthetic joint infection (PJI) is the most common mode of failure of megaprostheses, yet the literature on the topic is scarce, and studies report conflicting data regarding the optimal treatment strategy. Patients with megaprostheses PJI are often immunosuppressed, and surgeons must balance the trade-off between treatment efficacy and morbidity associated with the surgery aiming for infection eradication. Our review on megaprostheses PJI focuses on two axes: (1) risk factors and preventative strategies; and (2) surgical strategies to manage this condition. Risk factors were classified as either unmodifiable or modifiable. Attempts to decrease the risk of PJI should target the latter group. Strategies to prevent PJI include the use of silver-coated implants, timely discontinuation of perioperative antibiotic prophylaxis, and adequate soft tissue coverage to diminish the amount of dead space. Regarding surgical treatment, main strategies include debridement, antibiotics, implant retention (DAIR), DAIR with modular component exchange, stem retention (DAIR plus), one-stage, and two-stage revision. Two-stage revision is the "gold standard" for PJI in conventional implants; however, its success hinges on adequate soft tissue coverage and willingness of patients to tolerate a spacer for a minimum of 6 weeks. DAIR plus and one-stage revisions may be appropriate for a select group of patients who cannot endure the morbidity of two surgeries. Moreover, whenever DAIR is considered, exchange of the modular components should be performed (DAIR plus). Due to the low volume of megaprostheses implanted, studies assessing PJI should be conducted in a multi-institutional fashion. This would allow for more meaningful comparison of groups, with sufficient statistical power. Level of evidence: IV.
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Affiliation(s)
- Marcos R. Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.R.G.); (S.A.L.-C.)
| | - Juan Pretell-Mazzini
- Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL 33324, USA
| | - Santiago A. Lozano-Calderon
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (M.R.G.); (S.A.L.-C.)
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3
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Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
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Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
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Errani C, Mavrogenis AF, Tsukamoto S. What's new in musculoskeletal oncology. BMC Musculoskelet Disord 2021; 22:704. [PMID: 34404379 PMCID: PMC8369444 DOI: 10.1186/s12891-021-04590-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street Holargos, 15562, Athens, Greece
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Nara, 634-8521, Kashihara-city, Japan
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Imaging following surgery for primary appendicular bone tumours. Skeletal Radiol 2021; 50:1527-1555. [PMID: 33481074 DOI: 10.1007/s00256-021-03712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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Varenne Y, Corvec S, Leroy AG, Boutoille D, Nguyễn MV, Touchais S, Bémer P, Hamel A, Waast D, Nich C, Gouin F, Crenn V. A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection. Antibiotics (Basel) 2021; 10:768. [PMID: 34202518 PMCID: PMC8300712 DOI: 10.3390/antibiotics10070768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.
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Affiliation(s)
- Yoann Varenne
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Stéphane Corvec
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
- CRCINA, INSERM, University of Angers, University of Nantes, 44000 Nantes, France
| | - Anne-Gaëlle Leroy
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
- Laboratoire EA 3826 “Thérapeutiques Cliniques et Expérimentales des Infections”, IRS2-Nantes Biotech, University of Nantes, 44000 Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, 44000 Nantes, France;
| | - Mỹ-Vân Nguyễn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Sophie Touchais
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Pascale Bémer
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
| | - Antoine Hamel
- Pediatric Orthopedic Surgery Department, University Hospital, UHC of Nantes, 44903 Nantes, France;
- Anatomy Department, Medical Faculty, 44000 Nantes, France
| | - Denis Waast
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Christophe Nich
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- PhyOs 1238, INSERM, University of Nantes, 44000 Nantes, France
| | - François Gouin
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- Département de Chirurgie, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- PhyOs 1238, INSERM, University of Nantes, 44000 Nantes, France
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Pulik L, Grabowska N, Olbrys M, Gorecka K, Legosz P. Letter to the Editor: Disruption of the Gut Microbiome Increases the Risk of Periprosthetic Joint Infection in Mice. Clin Orthop Relat Res 2021; 479:855-857. [PMID: 33605632 PMCID: PMC8083926 DOI: 10.1097/corr.0000000000001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/22/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Lukasz Pulik
- L. Pulik, N. Grabowska, M. Olbrys, K. Gorecka, P. Legosz, Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- N. Grabowska, M. Olbrys, K. Gorecka, Department of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Nina Grabowska
- L. Pulik, N. Grabowska, M. Olbrys, K. Gorecka, P. Legosz, Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- N. Grabowska, M. Olbrys, K. Gorecka, Department of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Olbrys
- L. Pulik, N. Grabowska, M. Olbrys, K. Gorecka, P. Legosz, Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- N. Grabowska, M. Olbrys, K. Gorecka, Department of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Gorecka
- L. Pulik, N. Grabowska, M. Olbrys, K. Gorecka, P. Legosz, Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- N. Grabowska, M. Olbrys, K. Gorecka, Department of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Pawel Legosz
- L. Pulik, N. Grabowska, M. Olbrys, K. Gorecka, P. Legosz, Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- N. Grabowska, M. Olbrys, K. Gorecka, Department of Medicine, Medical University of Warsaw, Warsaw, Poland
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Ji T, Yang Y, Tang X, Liang H, Yan T, Yang R, Guo W. 3D-Printed Modular Hemipelvic Endoprosthetic Reconstruction Following Periacetabular Tumor Resection: Early Results of 80 Consecutive Cases. J Bone Joint Surg Am 2020; 102:1530-1541. [PMID: 32427766 DOI: 10.2106/jbjs.19.01437] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstruction with an endoprosthesis following pelvic tumor resection has increased over the years. However, the long-term results reflect a disappointing frequency of mechanical complications and failures. In an attempt to enhance implant fixation, an electron beam melting (EBM)-based modular hemipelvic endoprosthesis was introduced. Our aim was to explore the preliminary clinical outcomes for patients who have been managed with this prosthesis. METHODS We reviewed the records of 80 consecutive patients who had been managed at a single center between June 2015 and September 2017. Chondrosarcoma was the predominant diagnosis (31.3%). Osseous metastases were diagnosed in 16 patients (20.0%). The position of the reconstructed metallic acetabulum was measured on an anteroposterior pelvic radiograph. Bone ingrowth was evaluated in 2 samples harvested from patients with tumor recurrence. RESULTS After a median duration of follow-up of 32.5 months (range, 9 to 52 months), no acetabular component instability was detected on radiographs. Histological sectioning of specimens harvested from 2 patients with tumor recurrence showed bone trabeculae extending toward the implant and bone ingrowth within the porous network. At the time of the latest follow-up, 59 patients (73.8%) were alive with no evidence of disease, 5 patients (6.3%) were alive with disease, and 16 patients (20.0%) had died of disease. Local recurrence occurred in 9 patients (11.3%). The mean Musculoskeletal Tumor Society score at the time of the latest follow-up was 83.9% (range, 43% to 100%). Complications occurred in 16 patients (20%), with wound dehiscence being the most common complication (8 patients; 10%). No aseptic loosening was found. Five patients (6.3%) had deep infection, and 2 patients (2.5%) had dislocation. CONCLUSIONS The use of a 3-dimensional (3D)-printed modular hemipelvic endoprosthesis with a highly porous metal interface represents a potential choice as a pelvic endoprosthesis after internal hemipelvectomy for the treatment of a primary or metastatic tumor. These preliminary results demonstrate stable fixation with acceptable early functional and radiographic outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, People's Republic of China
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Kalbian IL, Goswami K, Tan TL, John N, Foltz C, Parvizi J, Arnold WV. Treatment Outcomes and Attrition in Gram-Negative Periprosthetic Joint Infection. J Arthroplasty 2020; 35:849-854. [PMID: 31679975 DOI: 10.1016/j.arth.2019.09.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND While the prevailing belief is that periprosthetic joint infection (PJI) caused by Gram-negative (GN) organisms confers a poorer prognosis than Gram-positive (GP) cases, the current literature is sparse and inconsistent. The purpose of this study is to compare the treatment outcomes for GN PJI vs GP PJI and Gram-mixed (GM) PJI. METHODS A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using our institutional PJI database. Treatment failure defined by international consensus criteria was compared between PJI caused by GN organisms (n = 45), GP organisms (n = 663), and GM (n = 28) cases. Multivariate regression was used to predict time to failure. RESULTS GM status, but not GN, had significantly higher rates of treatment failure compared to GP PJI (67.9% vs 33.2% failure; hazards ratio [HR] = 2.243, P = .004) in the multivariate analysis. In a subanalysis of only the 2-stage exchange procedures, both GN and GM cases were significantly less likely to reach reimplantation than GP cases (HR = .344, P < .0001; HR = .404, P = .013). CONCLUSION Although there was no observed difference in the overall international consensus failure rates between GN (31.1% failure) and GP (33.2%) PJI cases, there was significant attrition in the 2-stage exchange GN cohort, and these patients were significantly less likely to reach reimplantation. Our findings corroborate the prevailing notion that GN PJI is associated with poorer overall outcomes vs GP PJI. These data add to the current body of literature, which may currently underestimate the overall failure rates of GN PJI treated via 2-stage exchange and fail to identify pre-reimplantation morbidity.
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Affiliation(s)
- Irene L Kalbian
- Rothman Orthopaedic Institute, Philadelphia, PA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | | | - Nathan John
- Rothman Orthopaedic Institute, Philadelphia, PA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Carol Foltz
- Rothman Orthopaedic Institute, Philadelphia, PA
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Affiliation(s)
- Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Müller D, Kaiser D, Sairanen K, Studhalter T, Uçkay İ. Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts. J Bone Jt Infect 2019; 4:254-263. [PMID: 31966954 PMCID: PMC6960022 DOI: 10.7150/jbji.39050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of surgical site infections (SSIs) after elective tumour orthopaedic surgery in adults is higher than non-oncologic orthopaedic surgery. Their causative microorganisms and antibiotic susceptibilities are also different from the non-oncologic cases; with no apparent predictable microbiological patterns. Clinicians continue to struggle to tailor the optimal prophylactic regimen for the very heterogeneous group of tumour patients. Many clinicians thus prolong the first-and second-generation cephalosporin agents, while a minority chooses to broaden the antimicrobial spectrum by combination prophylaxis. The variability in current practices and surgical techniques is enormous, even within the same setting. The scientific literature lacks adequate retrospective case-studies and there is currently only one prospective randomized trial. In this narrative review, we discuss various perioperative antibiotic concepts in oncologic orthopaedic surgery, including a summary of the state-to-the-art, opinions and difficulties related to the different prophylactic strategies.
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Affiliation(s)
- Daniel Müller
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Dominik Kaiser
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Kati Sairanen
- Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
| | - Thorsten Studhalter
- Infectious Diseases and Infection Control, Balgrist University Hospital, Zurich, Switzerland
| | - İlker Uçkay
- Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
- Infectious Diseases and Infection Control, Balgrist University Hospital, Zurich, Switzerland
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