Risk Factors Related to Poor Outcomes in the Treatment of Non-conventional Periprosthetic Infection<sup/>

Viola, Dan Carai Maia; Rodrigues Neto, Henrique Ribeiro; Garcia, Jairo Greco; Petrilli, Marcelo de Toledo; Carlesse, Fabianne Altruda de Moraes Costa; Jesus-Garcia Filho, Reynaldo

doi:10.1055/s-0041-1731354

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Revista Brasileira de Ortopedia

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Original Article • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1731354 copy

Risk Factors Related to Poor Outcomes in the Treatment of Non-conventional Periprosthetic Infection^* * Study developed at Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), and at the Orthopedics and Traumatology Department (DOT), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To identify the main risk factors related to poor outcomes after the treatment for periprosthetic infection.

Materials and Methods

Medical records from 109 patients who underwent non-conventional endoprosthesis surgeries (primary and revision procedures) from January 1’ 2007’ to December 31’ 2018’ were retrospectively evaluated. In total’ 15 patients diagnosed with periprosthetic infection were eligible to participate in the study. Variables including gender’ ageatdiagnosis’ affected bone’ surgery duration’white blood cell (WBC) count before endoprosthesis placement’ urinary tract infection during the first postoperative year, and time elapsed from endoprosthesis placement to infection diagnosis were related to outcomes using the Fisherexact test (for the bicategorical variables) or analysis of variance (ANOVA’ for the tricategorical variables). The mean times from diagnosis to final outcome were compared using the Student t-test.

Results

These risk factors did not show a statistically significant correlation with the outcomes. The data revealed a trend towards a difference between the mean time for the onset of infection and the final outcome. Due to the limited sample, we believe that studies with larger cohorts can prove this trend.

Conclusion

We identified that the time from endoprosthesis placement to the onset of the symptoms of infection tends to be related to the outcome and evolution of the patient evolution during the treatment for periprosthetic infection. Although apparently correlated, other associated factors were not statistically linked to poor treatment outcomes.

Keywords
prosthesis and implants; sarcoma; infections; osteosarcoma; amputation; debridement

Gender	N	%
Male	7	46.7%
Female	8	53.3%
Age
Mean	20
Minimum	10
Maximum	31
Standard deviation	7.2
Diagnosis
Osteosarcoma	12	80.0%
Ewing sarcoma	2	13.3%
Undifferentiated sarcoma	1	6.7%
Tumor location
Femur	12	80.0%
Tibia	3	20.0%
Time from surgery to infection diagnosis
< 6 months	6	40.0%
6 to 12 months	2	13.3%
> 12 months	7	46.7%
Treatment performed
Surgical cleaning alone	5	33.3%
Revision in two stages using an acrylic cement spacer with antibiotics	9	60.0%
Revision in a single stage	1	6.7%

Variables	Limb preservation	Limb amputation	Statistical result
Gender			Fisher exact test
Male	6	1	0.250
Female	6	2
Diagnosis			Fisher exact test
Osteosarcoma	9	3	0.875
Not osteosarcoma	3	0
Affected bone			Fisher exact test
Femur	10	2	0.533
Tibia	2	1
Preoperative leukopenia			Fisher exact test
> 3,000 white blood cells	6	2	0.250
< 3,000 white blood cells	6	1
Urinary tract infection withing the first postoperative year			Fisher exact test
No	9	3	0.875
Yes	3	0
Surgery duration			Fisher exact test
≤ 300 minutes	4	2	1.037
> 300 minutes	8	1
Age			Fisher exact test
≤ 15 years	5	0	1.750
> 15 years	7	3
Time from surgery to infection diagnosis			Analysis of variance
< 6 months	6	0	0.269
6 to 12 months	1	1
> 12 months	5	2

Status	Time until infection (months)	Student t-test
Revision with limb preservation	23.7	0.027
Limb amputation	41.5	0.173
Surgical cleaning alone	6.7	0.247

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Dan Carai Maia Viola MD PhD Orthopedics and Traumatology Department Universidade Federal de São Paulo’ Rua Botucatu, 740 Vila Clementino São Paulo SP 04023062 Brazil (e-mail: dcmviola@gmail.com).