Pediatric deformity patients with stainless steel implants likely face challenges clearing SSIs

Issue: April 2015

LAS VEGAS — It was more difficult for pediatric patients who developed an infection after posterior surgery to treat spinal deformity to clear an infection if hardware used during the index surgery was made of stainless steel, according to results of a multicenter study of 101 patients presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

Investigators of the retrospective study identified pediatric patients who presented with a surgical site infection and required irrigation and debridement (I&D) within 3 months of posterior spinal fusion. To be included in the study, patients needed a minimum of 1 year follow-up.

Michael P. Glotzbecker, MD, noted in his presentation that the study did not examine whether patients became infected, but rather focused on factors associated with the patients’ ability to clear their infections.

The patients had a mean age of 13.8 years; 80 patients were treated successfully and cleared their infection and 21 patients were defined as having a recurrent infection because they later returned for treatment of the infection. Treatment in these instances typically involves hardware retention or exchange, as well as I&D, Glotzbecker said.

When Glotzbecker and his colleagues analyzed results with both types of hardware management, one factor – whether stainless steel hardware was used – made a difference in the patients’ ability to clear an acute infection.

“Acute postoperative spinal infections in pediatric deformity surgery can be treated with retention or immediate exchange of implants in a majority of cases. This represents about three-quarters of the patients that presented this way,” Glotzbecker said. “Patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals, and therefore, you may need to consider implant exchange to another metal if you do have stainless steel in this population,” he said.

From their multivariate analysis, the investigators found “stainless steel hardware and stainless steel implants had a five-times risk of recurrent infection … ,” Glotzbecker said.

The investigators found no differences between the two groups of patients for such factors as time to treatment after initial presentation, duration of antibiotic treatment, positive or negative microbiology cultures or whether a patient was fused to the pelvis, according to the abstract. – by Susan M. Rapp

Reference:

Glotzbecker MP, et al. Paper #96. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.