Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Definition of Infection
2.3. Surgical Procedure
2.4. Outcome Measurement
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Patients
3.2. Characteristics and Treatment of the Patients with Deep Periprosthetic Infection
3.3. Risk Factors for Deep Periprosthetic Infection in Tumor Prosthesis of the Lower Leg after Tumor Resection
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | body mass index |
CI | confidence interval |
DF | distal femur |
HR | hazard ratio |
PF | proximal femur |
PT | proximal tibia |
TF | total femur |
References
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Type of Prosthesis | |||||
---|---|---|---|---|---|
Parameter | Total | Total Femur | Proximal Femur | Distal Femur | Proximal Tibia |
Number | 121 | 7 | 47 | 47 | 20 |
Age at initial surgery (median, range) | 42.1 (42, 7–84) | 31.6 (16, 9–73) | 53.8 (58, 7–82) | 37.3 (26, 8–84) | 29.9 (19, 13–74) |
Sex | |||||
Male, n (%) | 67 (55) | 2 (29) | 26 (55) | 26 (55) | 10 (50) |
Female, n (%) | 54 (45) | 5 (71) | 21 (45) | 21 (45) | 10 (50) |
BMI at initial surgery (median, range) | 21.6 (21.2, 12.0–32.6) | 19.3 (18.8, 12.0–32.6) | 22.6 (22.7, 13.7–31.2) | 21.4 (20.4, 13.3–24.9) | 20.4 (20.1, 13.1–25.2) |
Tumor entity, n (%) | |||||
Bone tumor | 111 (92) | 7 (100) | 43 (91) | 42 (89) | 19 (95) |
Osteosarcoma | 45 (37) | 4 (57) | 2 (4) | 25 (53) | 14 (70) |
Chondrosarcoma | 17 (14) | 2 (29) | 8 (17) | 5 (11) | 2 (10) |
UPS | 3 (2) | 0 (0) | 2 (4) | 1 (2) | 0 (0) |
Leiomyosarcoma | 2 (2) | 0 (0) | 0 (0) | 2 (4) | 0 (0) |
Ewing sarcoma | 1 (1) | 1 (14) | 0 (0) | 0 (0) | 0 (0) |
Epithelioid angiosarcoma | 1 (1) | 0 (0) | 0 (0) | 1 (2) | 0 (0) |
GCT of bone | 6 (5) | 0 (0) | 0 (0) | 4 (9) | 2 (10) |
Bone metastases | 36 (30) | 0 (0) | 31 (66) | 4 (9) | 1 (5) |
Soft tissue tumor | 10 (8) | 0 (0) | 4 (9) | 5 (11) | 1 (5) |
Synovial sarcoma | 3 (2) | 0 (0) | 2 (4) | 1 (2) | 0 (0) |
UPS | 3 (2) | 0 (0) | 2 (4) | 1 (2) | 0 (0) |
Leiomyosarcoma | 2 (2) | 0 (0) | 0 (0) | 1 (2) | 1 (5) |
ASPS | 1 (1) | 0 (0) | 0 (0) | 1 (2) | 0 (0) |
Diffuse type GCT of TS | 1 (1) | 0 (0) | 0 (0) | 1 (2) | 0 (0) |
Surgery before prosthesis, n (%) | 10 (8) | 0 (0) | 3 (6) | 5 (11) | 2 (10) |
Type of implant, n (%) | |||||
KMFTR | 2 (2) | 2 (29) | 0 (0) | 0 (0) | 0 (0) |
Growing Kotz | 7 (6) | 3 (43) | 0 (0) | 4 (9) | 0 (0) |
KLS | 2 (2) | 0 (0) | 1 (2) | 0 (0) | 1 (5) |
OSS | 1 (1) | 0 (0) | 1 (2) | 0 (0) | 0 (0) |
HMRS | 81 (67) | 2 (29) | 31 (66) | 34 (72) | 14 (70) |
GMRS | 28 (23) | 0 (0) | 14 (30) | 9 (19) | 5 (25) |
Operative time, minute (median, range) | 229 (210, 100–856) | 229 (207, 174–330) | 213 (191, 100–515) | 235 (212, 100–856) | 253 (215, 123–511) |
Follow-up duration, year (median, range) | 5.9 (4.2, 0.1–19.8) | 5.8 (4.9, 1.2–13.8) | 4.9 (3.0, 0.1–18.1) | 6.4 (4.9, 0.3–17.9) | 6.6 (5.9, 0.1–19.8) |
Oncological status, n (%) | |||||
CDF | 51 (42) | 0 (0) | 16 (34) | 23 (49) | 12 (60) |
NED | 18 (15) | 1 (14) | 3 (6) | 10 (21) | 4 (20) |
AWD | 16 (13) | 0 (0) | 13 (28) | 3 (6) | 0 (0) |
DOD | 36 (30) | 6 (86) | 15 (32) | 11 (23) | 4 (20) |
Adjuvant treatments, n (%) | |||||
Chemotherapy | 65 (54) | 5 (71) | 18 (38) | 28 (68) | 14 (70) |
Bone tumor | 61 (50) | 5 (71) | 15 (32) | 27 (57) | 14 (70) |
Soft tissue tumor | 4 (3) | 0 (0) | 3 (6) | 1 (2) | 0 (0) |
Local radiotherapy | 11 (9) | 1 (14) | 9 (19) | 1 (2) | 0 (0) |
Bone tumor | 10 (8) | 1 (14) | 8 (17) | 1 (2) | 0 (0) |
Soft tissue tumor | 1 (1) | 0 (0) | 1 (2) | 0 (0) | 0 (0) |
Noninfected reoperation | 17 (14) | 1 (14) | 6 (13) | 8 (17) | 2 (10) |
Extension of prosthesis | 2 (2) | 0 (0) | 0 (0) | 2 (4) | 0 (0) |
Open reduction for dislocation | 3 (2) | 0 (0) | 3 (6) | 0 (0) | 0 (0) |
Revision | 7 (6) | 0 (0) | 2 (4) | 4 (9) | 1 (5) |
Resection of soft tissue tumor | 1 (1) | 0 (0) | 1 (2) | 0 (0) | 0 (0) |
Osteosynthesis | 1 (1) | 0 (0) | 0 (0) | 0 (0) | 1 (5) |
Secondary suture | 1 (1) | 1 (14) | 0 (0) | 0 (0) | 0 (0) |
Relaxation incision | 1 (1) | 0 (0) | 0 (0) | 1 (2) | 0 (0) |
Re-inosculation of musculocutaneous flap | 1 (1) | 0 (0) | 0 (0) | 1 (2) | 0 (0) |
Complication | |||||
Diabetes mellitus, n (%) | 11 (9) | 0 (0) | 5 (11) | 6 (13) | 0(0) |
Deep infection, n (%) | 14 (12) | 0 (0) | 3 (6) | 7 (15) | 4 (20) |
No. | Location | Sex | Age | Diagnosis | Bone/Soft Tissue | Implant | Time to Infection, Days | Organism | First Stage, n | Second Stage | Status of Tumor | Follow-up Duration, Year |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | PF | M | 25 | Osteosarcoma | Bone | HMRS | 2325 | Staphylococcus epidermidis | 4 | No | CDF | 15.8 |
2 | PF | M | 52 | Bone metastasis | Bone | HMRS | 3993 | Staphylococcus epidermidis | 4 | Secondary Revision | CDF | 17.6 |
3 | PF | F | 59 | Synovial sarcoma | Soft tissue | HMRS | 63 | Staphylococcus species | 1 | No | DOD | 0.6 |
4 | DF | M | 19 | Osteosarcoma | Bone | HMRS | 1033 | Staphylococcus epidermidis | 3 | No | CDF | 17.9 |
5 | DF | M | 20 | Osteosarcoma | Bone | HMRS | 5825 | Salmonella | 1 | No | CDF | 16.8 |
6 | DF | M | 11 | Osteosarcoma | Bone | Growing Kotz | 66 | MRSA | 1 | Amputation | CDF | 6.7 |
7 | DF | M | 61 | UPS | Bone | HMRS | 30 | Staphylococcus lugdunensis | 1 | No | CDF | 7.4 |
8 | DF | F | 21 | Synovial sarcoma | Soft tissue | HMRS | 55 | Staphylococcus epidermidis | 4 | No | CDF | 14.3 |
9 | DF | F | 73 | Leiomyosarcoma | Soft tissue | GMRS | 40 | Escherichia coli | 1 | No | DOD | 3.7 |
10 | DF | M | 30 | GCT of bone | Bone | HMRS | 1621 | Staphylococcus aureus | 2 | No | CDF | 15.4 |
11 | PT | M | 14 | Osteosarcoma | Bone | HMRS | 1797 | Staphylococcus species | 2 | No | DOD | 7.7 |
12 | PT | F | 74 | Leiomyosarcoma | Soft tissue | HMRS | 1561 | Unknown | 1 | No | CDF | 10.4 |
13 | PT | M | 40 | GCT of bone | Bone | HMRS | 1878 | Staphylococcus aureus | 1 | Musculocutaneous flap | CDF | 7.6 |
14 | PT | M | 17 | Osteosarcoma | Bone | HMRS | 33 | MRSA | 2 | No | CDF | 9.8 |
Variable | Noninfection (n = 107) | Infection (n = 14) | p-Value |
---|---|---|---|
Age, y, mean (median, range) | 42.8 (44, 7–84) | 36.9 (28, 11–74) | 0.4985 |
Sex (male), n (%) | 57 (53%) | 10 (71%) | 0.1987 |
BMI, mean (median, range) | 21.6 (21.2, 12.1–32.7) | 21.6 (21.6, 18.5–27.5) | 0.7245 |
Soft-tissue tumor, n (%) | 6 (6%) | 4 (29%) | 0.0033 |
Location (PT vs. others), n (%) | 16 (15%) | 4 (29%) | 0.1970 |
Primary (or metastasis), n (%) | 72 (67%) | 13 (93%) | 0.0491 |
Previous surgery, n (%) | 6 (6%) | 4 (29%) | 0.0033 |
Curettage (3), Resection of soft-tissue tumor (2), Osteosynthesis for femoral fracture (1) | Curettage (3), Resection of soft-tissue tumor (1) | ||
Operative time, min | 222.2 ± 83.5 (210, 100–542) | 284.9 ± 205.0 (218, 100–856) | 0.5928 |
Chemotherapy, n (%) | 58 (54%) | 7 (50%) | 0.7666 |
Local radiotherapy, n (%) | 9 (8%) | 2 (14%) | 0.4721 |
Bone tumor (8), Soft tissue tumor (1) | Bone tumor (2) | ||
Noninfected reoperation, n (%) | 13 (12%) | 4 (29%) | 0.0964 |
Extension of prosthesis (2), Open reduction for dislocation (1), Revision (7), Resection of soft-tissue tumor (1), Osteosynthesis (1), Secondary suture (1) | Open reduction for dislocation (2), Relaxation incision (1), Re-inosculation of musculocutaneous flap (1) | ||
Diabetes mellitus, n (%) | 10 (9%) | 1 (7%) | 0.7874 |
Death at final, n (%) | 33 (31%) | 3 (21%) | 0.4565 |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p-Value | HR | 95% CI | p-Value | |
Sex (male) | 1.8882 | 0.5910–6.0323 | 0.2835 | 11.2316 | 1.7843–70.7002 | 0.0100 |
Soft-tissue tumor | 7.7133 | 2.3008–25.8587 | 0.0009 | 52.2443 | 6.0707–449.6165 | 0.0003 |
Location (PT) | 1.5367 | 0.4788–4.9319 | 0.4702 | 3.0272 | 0.7482–12.2481 | 0.1204 |
Previous surgery | 7.2761 | 2.1029–25.1756 | 0.0017 | 2.7128 | 0.6113–12.0396 | 0.1893 |
Operative time | 1.0055 | 1.0019–1.0085 | 0.0006 | 1.0056 | 1.0009–1.0103 | 0.0184 |
Noninfected-reoperation | 0.9290 | 0.2799–3.0829 | 0.9042 | 0.4445 | 0.1015–1.9473 | 0.2820 |
Chemotherapy | 0.8250 | 0.2878–2.3651 | 0.7204 | 0.5811 | 0.1706–1.9793 | 0.3853 |
Local radiotherapy | 2.1065 | 0.4583–9.6828 | 0.3384 | 6.5683 | 1.0199–42.3017 | 0.0476 |
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Fujiwara, T.; Ebihara, T.; Kitade, K.; Setsu, N.; Endo, M.; Iida, K.; Matsumoto, Y.; Matsunobu, T.; Oda, Y.; Iwamoto, Y.; et al. Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb. J. Clin. Med. 2020, 9, 3133. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103133
Fujiwara T, Ebihara T, Kitade K, Setsu N, Endo M, Iida K, Matsumoto Y, Matsunobu T, Oda Y, Iwamoto Y, et al. Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb. Journal of Clinical Medicine. 2020; 9(10):3133. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103133
Chicago/Turabian StyleFujiwara, Toshifumi, Toshihiro Ebihara, Kazuki Kitade, Nokitaka Setsu, Makoto Endo, Keiichiro Iida, Yoshihiro Matsumoto, Tomoya Matsunobu, Yoshinao Oda, Yukihide Iwamoto, and et al. 2020. "Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb" Journal of Clinical Medicine 9, no. 10: 3133. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103133