Poor soft tissue, enterococcal infection linked with recurrent endoprosthetic infection
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Results showed compromised soft tissue status and Enterococcus spp. infection was associated with increased risk of recurrent infection in endoprosthetic replacement for patients with primary bone sarcomas or metastatic bone disease.
In a single-center cohort study, researchers analyzed 99 patients (median age of 44 years) who were treated for infected endoprosthetic replacement (EPR) between 2010 and 2020. Tumor types included osteosarcoma (n = 47), chondrosarcoma (n = 23), Ewing’s sarcoma (n = 7), other soft tissue or bone sarcoma (n = 7), giant cell bone tumor (n =7) and metastatic bone disease (n = 8).
According to the study, median time to first infection was 6.1 years. Outcome measures included survival analysis, defined as time to recurrent infection at 1-, 2- and 4-year intervals, as well as Cox regression analysis, which assessed the influence of variables on recurrent infection.
Overall, 133 surgical treatments for EPR infections were performed. Success rates at 2-year follow-up were 55.3% for two-stage exchange, 45.5% for one-stage exchange, 44.6% for debridement, antibiotics and implant retention (DAIR) with exchange of modular components and 24.7% for DAIR without exchange of modular components.
At final follow-up, 52% of patients were infection-free, while 27% required antibiotic suppression and 21% required amputation. Regression analysis revealed DAIR without exchange of modular components, compromised soft tissue status and Enterococcus spp. infection were all risk factors for recurrent EPR infection. Researchers also noted two-stage exchange with complete component removal was associated with the lowest risk of recurrent infection.
“Infected EPR remains a significant challenge in orthopedic oncology,” the researchers wrote in the study. “Identification of risk factors, timely assessment and a multidisciplinary approach should be available to manage these complex infections,” they added.
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