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Titanium alloy less susceptible than stainless steel alloy to late postoperative infection in patients treated for adolescent idiopathic scoliosis
Silvestre, MD. Eur Spine J. Published online April 20, 2011. doi: 10.1007/s00586-011-1754-1.
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Titanium alloy instrumentations are less susceptible to late postoperative infections when compared with stainless steel instrumentations in patients treated for adolescent idiopathic scoliosis, according to a study from Bologna, Italy.
Mario Di Silvestre, MD, and his colleagues performed a retrospective case series review of patients with adolescent idiopathic scoliosis (AIS) who underwent revision for late-developing deep wound infection 1 or more years after the initial procedure. The group sought to determine onset, bacteriology, possible influence of implant alloy and treatment outcome.
Of the 540 patients who underwent posterior-only fusion for AIS from 1993 through 2005, 15 (2.77%) were revised for a reported late-developing postoperative infection. Average age at the time of initial surgery, the study reported, was 15.8 years. Infections occurred at a mean of 70 months after the initial surgery.
The group found 11 of the 15 infected patients received stainless steel instrumentation (4.56% of 241), with four of the 15 patients having received titanium instrumentation (1.33% of 299). Complete removal of instrumentation was deemed necessary in nine patients, with wound healing and a lack of infection symptoms at a minimum follow-up of 3 years.
The other six patients, the study reported, presented less severe signs of infection and thus underwent efforts to save or replace previous instrumentation. Ultimately, all had to undergo complete instrumentation removal. All, however, healed uneventfully by the 3-year follow-up.
None of the patients in the study displayed scoliosis progression at the latest follow-up, as there were no statistically significant differences between final and preoperative surgery values.
“In conclusion, treatment of late-developing postoperative infection in AIS surgery required complete removal of the implant, continuous drain and adequate antibiotic therapy based on intraoperative swab antibiogram,” the authors wrote. “Titanium allow instrumentations were less subject to late postoperative infections when compared to stainless steel ones.”