Patient and Surgical Risk Factors for Surgical Site Infection in Lower-Extremity Oncological Endoprosthetic Reconstruction: A Secondary Analysis of the PARITY Trial Data

Risk factors for surgical site infections after orthopaedic surgery: A meta-analysis and systematic review

The objective of this meta-analysis was to investigate the occurrence and determinants of surgical site infections (SSIs) in individuals following orthopaedic surgical procedures. A systematic exploration of articles concerning factors predisposing individuals to SSIs after orthopaedic surgery was conducted across multiple databases, including PubMed, Embase, Cochrane Library and Web of Science, up to March 20, 2024. The Stata 15.0 software was employed to estimate combined odds ratios (ORs) utilizing either a random-effects model or a fixed-effects model based on the degree of heterogeneity among the included studies. Egger's test was used to assess publication bias. Among the 1248 records retrieved, 45 articles were deemed eligible after screening for studies incorporating multivariate analyses of risk factors associated with SSIs. These comprised four case-control studies and 41 cohort studies, collectively involving 1 572 160 patients, among whom 43 971 cases of SSIs were reported postoperatively. Meta-analysis outcomes indicated significant associations between SSIs and the following factors: low Albumin levels (<35 g/L; OR = 2.29, 95% confidence interval [CI]: 1.45-3.62, p = 0.0001), ASA score >2 (OR = 2.32, 95% CI: 1.86-2.89, p = 0.0001), elevated body mass index (BMI) (>24 kg/m2) (OR = 2.15, 95% CI: 1.60-2.90, p = 0.0001), diabetes (OR = 2.25, 95% CI: 1.66-3.05, p = 0.0001), prolonged surgical duration (>60 min) (OR = 2.06, 95% CI: 1.52-2.80, p = 0.001), undergoing multiple surgeries/procedures (OR = 2.38, 95% CI: 1.29-4.41, p = 0.006), presence of an open fracture (OR = 3.35, 95% CI: 2.51-4.46, p = 0.001), current smoking (OR = 2.87, 95% CI: 1.88-4.37, p = 0.0001), higher wound class (>2; OR = 3.59, 95% CI: 1.68-7.66, p = 0.001) and utilization of implants (OR = 1.89, 95% CI: 1.15-3.11, p = 0.0012). The present study identified a number of risk factors for the development of SSIs following orthopaedic surgery. It is therefore recommended that clinicians closely monitor these indicators in order to prevent the development of postoperative SSIs. Furthermore, our interpretation of diabetes mellitus was not adequate. It is therefore recommended that future studies refine the effect of diabetes mellitus on SSIs in different situations.

Proximal Humerus Reconstruction for Bone Sarcomas: A Critical Analysis

» The proximal humerus is a common location for primary bone tumors, and the goal of surgical care is to obtain a negative margin resection and subsequent reconstruction of the proximal humerus to allow for shoulder function.» The current evidence supports the use of reverse total shoulder arthroplasty over hemiarthroplasty when reconstructing the proximal humerus after resection of a bone sarcoma if the axillary nerve can be preserved.» There is a lack of high-quality data comparing allograft prosthetic composite (APC) with endoprosthetic reconstruction of the proximal humerus.» Reverse APC should be performed using an allograft with donor rotator cuff to allow for soft-tissue repair of the donor and host rotator cuff, leading to improvements in shoulder motion compared with an endoprosthesis.

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses-A Review of the Literature

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.