Periprosthetic Infection in Patients Treated for an Orthopaedic Oncological Condition

Background: Prosthetic replacement following excision of a bone tumor can be complicated by infection because patients who undergo surgery for a neoplastic condition often are subjected to extensive soft-tissue dissection and long operating times and are immunosuppressed. The aim of this study was to investigate the rate of periprosthetic infection, identify possible predisposing factors, and assess treatment efficacy in such patients.

Methods: Prosthetic reconstruction was performed in 1264 patients over a thirty-seven-year period in a single hospital by four surgeons. Twenty-four patients were excluded because of incomplete follow-up, leaving 1240 patients who had been followed for a mean of 5.8 years. Infection was identified in 136 patients (11.0%). The management and outcome of the infections in all of these patients were analyzed.

Results: Coagulase-negative Staphylococcus was the most common organism isolated. Two-stage revision successfully treated the infection in 72% (forty-two) of the fifty-eight patients in whom it was performed. Local surgical débridement with or without antibiotic implants was successful in only 6% (four) of sixty-eight patients. Amputation to treat the infection was performed in fifty (37%) of the 136 patients. The factors that were associated with a significant risk of infection (p ≤ 0.05) included tibial and pelvic prosthetic replacements, radiation therapy, and the use of a pediatric expandable prosthesis.

Conclusions: Patients treated with an orthopaedic procedure for an oncological condition have high infection rates. The treatment of infection in these patients is arduous and lengthy, with a substantial risk of amputation.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.