Postoperative deep infection in tumor endoprosthesis reconstruction around the knee

Takeshi Morii, Hiroo Yabe, Hideo Morioka, Yasuo Beppu, Hirokazu Chuman, Akira Kawai, Ken Takeda, Kazutaka Kikuta, Seiichi Hosaka, Yasuo Yazawa, Katsuhito Takeuchi, Ukei Anazawa, Kazuo Mochizuki, Kazuhiko Satomi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background. Although deep infection remains one of the most diffi cult complications to manage in the treatment of musculoskeletal tumor reconstructed with an endoprosthesis, limited information with respect to its incidence and risk factors has been reported. Methods. This multicenter, retrospective, uncontrolled study reviewed the medical records of 82 patients who underwent reconstruction with an endoprosthesis or temporary spacer for bone-immature patients after resection of malignant bone tumor around the knee. Risk factors for deep infection and the impact of deep infection on prosthesis survival and oncological outcomes were analyzed. Deep infection was defi ned according to the Centers for Disease Control and Prevention (CDC) guidelines with minor modifi cation. Results. Deep infection occurred in 14 cases (17%), identifi ed at a mean of 10.9 months (range <1 to 48 months) after initial surgery. Univariate analysis identifi ed surface infection (P < 0.001) and skin necrosis (P < 0.001) as risk factors associated with deep infection. Conversely, tumor origin, chemotherapy, number of postoperative antibiotics, and length of bone resection were not associated with infection. Subclass analysis in femur cases identifi ed a correlation between infection and the extent of partial resection of the quadriceps muscle (P = 0.04). In the multivariate analysis, surface infection represented an independent risk factor for deep infection (P = 0.03). Deep infection was a risk for endoprosthesis survival (P = 0.003) but did not affect the oncological outcome. Conclusions. A strong correlation between the condition of soft tissue and establishment of deep infection is suggested in this study. Although practical options for preventing deep infection seem limited, the present data allow a form of perioperative evaluation for patients with a higher risk of deep infection.

Original languageEnglish
Pages (from-to)331-339
Number of pages9
JournalJournal of Orthopaedic Science
Volume15
Issue number3
DOIs
Publication statusPublished - 2010

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Knee
Infection
Neoplasms
Bone and Bones
Prosthesis Failure
Quadriceps Muscle
Centers for Disease Control and Prevention (U.S.)
Femur
Medical Records
Cations
Necrosis
Multivariate Analysis
Retrospective Studies
Guidelines
Anti-Bacterial Agents
Drug Therapy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Morii, T., Yabe, H., Morioka, H., Beppu, Y., Chuman, H., Kawai, A., ... Satomi, K. (2010). Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. Journal of Orthopaedic Science, 15(3), 331-339. https://doi.org/10.1007/s00776-010-1467-z

Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. / Morii, Takeshi; Yabe, Hiroo; Morioka, Hideo; Beppu, Yasuo; Chuman, Hirokazu; Kawai, Akira; Takeda, Ken; Kikuta, Kazutaka; Hosaka, Seiichi; Yazawa, Yasuo; Takeuchi, Katsuhito; Anazawa, Ukei; Mochizuki, Kazuo; Satomi, Kazuhiko.

In: Journal of Orthopaedic Science, Vol. 15, No. 3, 2010, p. 331-339.

Research output: Contribution to journalArticle

Morii, T, Yabe, H, Morioka, H, Beppu, Y, Chuman, H, Kawai, A, Takeda, K, Kikuta, K, Hosaka, S, Yazawa, Y, Takeuchi, K, Anazawa, U, Mochizuki, K & Satomi, K 2010, 'Postoperative deep infection in tumor endoprosthesis reconstruction around the knee', Journal of Orthopaedic Science, vol. 15, no. 3, pp. 331-339. https://doi.org/10.1007/s00776-010-1467-z
Morii, Takeshi ; Yabe, Hiroo ; Morioka, Hideo ; Beppu, Yasuo ; Chuman, Hirokazu ; Kawai, Akira ; Takeda, Ken ; Kikuta, Kazutaka ; Hosaka, Seiichi ; Yazawa, Yasuo ; Takeuchi, Katsuhito ; Anazawa, Ukei ; Mochizuki, Kazuo ; Satomi, Kazuhiko. / Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. In: Journal of Orthopaedic Science. 2010 ; Vol. 15, No. 3. pp. 331-339.
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abstract = "Background. Although deep infection remains one of the most diffi cult complications to manage in the treatment of musculoskeletal tumor reconstructed with an endoprosthesis, limited information with respect to its incidence and risk factors has been reported. Methods. This multicenter, retrospective, uncontrolled study reviewed the medical records of 82 patients who underwent reconstruction with an endoprosthesis or temporary spacer for bone-immature patients after resection of malignant bone tumor around the knee. Risk factors for deep infection and the impact of deep infection on prosthesis survival and oncological outcomes were analyzed. Deep infection was defi ned according to the Centers for Disease Control and Prevention (CDC) guidelines with minor modifi cation. Results. Deep infection occurred in 14 cases (17{\%}), identifi ed at a mean of 10.9 months (range <1 to 48 months) after initial surgery. Univariate analysis identifi ed surface infection (P < 0.001) and skin necrosis (P < 0.001) as risk factors associated with deep infection. Conversely, tumor origin, chemotherapy, number of postoperative antibiotics, and length of bone resection were not associated with infection. Subclass analysis in femur cases identifi ed a correlation between infection and the extent of partial resection of the quadriceps muscle (P = 0.04). In the multivariate analysis, surface infection represented an independent risk factor for deep infection (P = 0.03). Deep infection was a risk for endoprosthesis survival (P = 0.003) but did not affect the oncological outcome. Conclusions. A strong correlation between the condition of soft tissue and establishment of deep infection is suggested in this study. Although practical options for preventing deep infection seem limited, the present data allow a form of perioperative evaluation for patients with a higher risk of deep infection.",
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AU - Morii, Takeshi

AU - Yabe, Hiroo

AU - Morioka, Hideo

AU - Beppu, Yasuo

AU - Chuman, Hirokazu

AU - Kawai, Akira

AU - Takeda, Ken

AU - Kikuta, Kazutaka

AU - Hosaka, Seiichi

AU - Yazawa, Yasuo

AU - Takeuchi, Katsuhito

AU - Anazawa, Ukei

AU - Mochizuki, Kazuo

AU - Satomi, Kazuhiko

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N2 - Background. Although deep infection remains one of the most diffi cult complications to manage in the treatment of musculoskeletal tumor reconstructed with an endoprosthesis, limited information with respect to its incidence and risk factors has been reported. Methods. This multicenter, retrospective, uncontrolled study reviewed the medical records of 82 patients who underwent reconstruction with an endoprosthesis or temporary spacer for bone-immature patients after resection of malignant bone tumor around the knee. Risk factors for deep infection and the impact of deep infection on prosthesis survival and oncological outcomes were analyzed. Deep infection was defi ned according to the Centers for Disease Control and Prevention (CDC) guidelines with minor modifi cation. Results. Deep infection occurred in 14 cases (17%), identifi ed at a mean of 10.9 months (range <1 to 48 months) after initial surgery. Univariate analysis identifi ed surface infection (P < 0.001) and skin necrosis (P < 0.001) as risk factors associated with deep infection. Conversely, tumor origin, chemotherapy, number of postoperative antibiotics, and length of bone resection were not associated with infection. Subclass analysis in femur cases identifi ed a correlation between infection and the extent of partial resection of the quadriceps muscle (P = 0.04). In the multivariate analysis, surface infection represented an independent risk factor for deep infection (P = 0.03). Deep infection was a risk for endoprosthesis survival (P = 0.003) but did not affect the oncological outcome. Conclusions. A strong correlation between the condition of soft tissue and establishment of deep infection is suggested in this study. Although practical options for preventing deep infection seem limited, the present data allow a form of perioperative evaluation for patients with a higher risk of deep infection.

AB - Background. Although deep infection remains one of the most diffi cult complications to manage in the treatment of musculoskeletal tumor reconstructed with an endoprosthesis, limited information with respect to its incidence and risk factors has been reported. Methods. This multicenter, retrospective, uncontrolled study reviewed the medical records of 82 patients who underwent reconstruction with an endoprosthesis or temporary spacer for bone-immature patients after resection of malignant bone tumor around the knee. Risk factors for deep infection and the impact of deep infection on prosthesis survival and oncological outcomes were analyzed. Deep infection was defi ned according to the Centers for Disease Control and Prevention (CDC) guidelines with minor modifi cation. Results. Deep infection occurred in 14 cases (17%), identifi ed at a mean of 10.9 months (range <1 to 48 months) after initial surgery. Univariate analysis identifi ed surface infection (P < 0.001) and skin necrosis (P < 0.001) as risk factors associated with deep infection. Conversely, tumor origin, chemotherapy, number of postoperative antibiotics, and length of bone resection were not associated with infection. Subclass analysis in femur cases identifi ed a correlation between infection and the extent of partial resection of the quadriceps muscle (P = 0.04). In the multivariate analysis, surface infection represented an independent risk factor for deep infection (P = 0.03). Deep infection was a risk for endoprosthesis survival (P = 0.003) but did not affect the oncological outcome. Conclusions. A strong correlation between the condition of soft tissue and establishment of deep infection is suggested in this study. Although practical options for preventing deep infection seem limited, the present data allow a form of perioperative evaluation for patients with a higher risk of deep infection.

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