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Perioperative Infection Rate in Patients with Osteosarcomas Treated with Resection and Prosthetic Reconstruction

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The incidence of perioperative infection after segmental tumor endoprosthetic replacement in previous reports varies from a high of 7.4% to a low of 2.6%. Appropriate antibiotic use for this group is unknown and controversial, whereas the relationship of antibiotic use and perioperative infection is unclear.

Questions/purposes

We determined the incidence of perioperative infection in patients with osteosarcoma treated with segmental prosthetic replacement using a standard perioperative antibiotic regimen and the incidence of late infections and wound complications.

Patients and Methods

We retrospectively reviewed the records of 53 patients with osteosarcoma undergoing segmental prosthetic replacements from 1993 to 2008. There were 30 males and 23 females ranging from 10 to 78 years of age. All patients were given intraoperative antibiotics (intravenous cefazolin), continued for 3 days postoperatively and then given orally for 5 days. Patients who were allergic to penicillin or cefazolin were given vancomycin followed by clindamycin. A perioperative infection was defined as a deep infection within 2 months after prosthetic reconstruction. The minimum followup was 1 year (range, 1–15 years).

Results

We identified one confirmed perioperative prosthetic infection (1/53; 1.9%) (Enterobacter cloacae and methicillin-resistant Staphylococcus) in a 78-year-old woman after proximal tibial replacement, gastrocnemius flap, and skin graft. Her infection was controlled with débridement, drainage, and intravenous antibiotics. Three patients had late infections, two of which were culture negative. Four patients had wound complications that required further surgery.

Conclusion

The antibiotic regimen we used is longer than that recommended for patients having routine total joint arthroplasty. Its appropriateness will require comparison with alternate regimens, including those of shorter duration.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Linda D. Pickron for assistance with collecting all the medical charts for this research.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China

    Xin Li MD

  2. Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 S 8th Street, Philadelphia, PA, 19106-6192, USA

    Vincent M. Moretti MD, Adedayo O. Ashana BA & Richard D. Lackman MD

Authors
  1. Xin Li MD
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  2. Vincent M. Moretti MD
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  3. Adedayo O. Ashana BA
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  4. Richard D. Lackman MD
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Corresponding author

Correspondence to Richard D. Lackman MD.

Additional information

One of the authors (XL) received funding in the form of a visiting scholarship from the China Scholarship Council. Two of the authors (VMM, AOA) received funding in the form of a research fellowship from Stryker Orthopaedics, Mahwah, NJ. One of the authors (RDL) is a consultant for Stryker Orthopaedics, Mahwah, NJ.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles for research.

This work was performed at the University of Pennsylvania, Philadelphia, PA, USA.

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Li, X., Moretti, V.M., Ashana, A.O. et al. Perioperative Infection Rate in Patients with Osteosarcomas Treated with Resection and Prosthetic Reconstruction. Clin Orthop Relat Res 469, 2889–2894 (2011). https://doi.org/10.1007/s11999-011-1877-z

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  • DOI: https://doi.org/10.1007/s11999-011-1877-z

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