Limits...
Persistent wound drainage after tumor resection and endoprosthetic reconstruction of the proximal femur.

Hettwer WH, Horstmann PF, Grum-Schwensen TA, Petersen MM - Open Orthop J (2014)

Bottom Line: PWD for 7 days or more was observed in 41 cases (48%).The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics (mean 8.7 days) and length of hospital stay (mean 10.2 days).Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication are warranted.

View Article: PubMed Central - PubMed

Affiliation: Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.

ABSTRACT

Purpose: To examine the prevalence of prolonged wound drainage (PWD) after tumor resection and endoprosthetic reconstruction of the hip.

Methods: Retrospective review of 86 consecutive patients with metastatic bone disease, malignant hematologic bone disease or bone sarcoma, treated with tumor resection and subsequent endoprosthetic reconstruction of the proximal femur, between 2010 and 2012, in a single center.

Results: PWD for 7 days or more was observed in 41 cases (48%). The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics (mean 8.7 days) and length of hospital stay (mean 10.2 days). Total femur replacement, bone sarcoma and additional pelvic reconstruction were identified as significant independent risk factors for an even longer duration of PWD.

Conclusion: Compared to conventional hip arthroplasty, PWD appears to be significantly more prevalent in patients undergoing tumor arthroplasty procedures of the hip. Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication are warranted.

No MeSH data available.


Related in: MedlinePlus

A: Conventional neck resection (for a pathological femoral head fracture), reconstructed with a full length (350mm), cementedstandard stem (Link SPII), to bridge metastatic involvement of the distal femur. Note screw fixation and cement augmentation for a partiallyhealed pathological fracture in the superior acetabular rim. B: Conventional calcar resection (for a pathological femoral neck fracture) andreconstruction of the proximal femur with a cemented modular revision prosthesis (Link MP). Note reconstruction and cement augmentationof a large concurrent acetabular lesion with a pelvic reconstruction cage (Link Partial Pelvic Replacement). C: Proximal femur resection(15cm), reconstructed with a long, cemented mega-prosthesis (Zimmer Segmental System) and a cemented (Link Lubinus Eccentric)acetabular component. Note screw fixation of a polyethylene anti luxation device.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4300510&req=5

Figure 1: A: Conventional neck resection (for a pathological femoral head fracture), reconstructed with a full length (350mm), cementedstandard stem (Link SPII), to bridge metastatic involvement of the distal femur. Note screw fixation and cement augmentation for a partiallyhealed pathological fracture in the superior acetabular rim. B: Conventional calcar resection (for a pathological femoral neck fracture) andreconstruction of the proximal femur with a cemented modular revision prosthesis (Link MP). Note reconstruction and cement augmentationof a large concurrent acetabular lesion with a pelvic reconstruction cage (Link Partial Pelvic Replacement). C: Proximal femur resection(15cm), reconstructed with a long, cemented mega-prosthesis (Zimmer Segmental System) and a cemented (Link Lubinus Eccentric)acetabular component. Note screw fixation of a polyethylene anti luxation device.

Mentions: We retrospectively reviewed the medical records of all patients with metastatic bone disease, malignant hematologic bone disease and bone sarcoma, who underwent endoprosthetic reconstruction of the proximal femur in our specialized orthopedic oncology unit between 2010 and 2012. All relevant data (age, gender, nature and location of pathology, details of the surgical procedure, implants used, duration of antibiotic treatment, preoperative radiation therapy, hospital stay and time to a dry surgical wound) were collected from the patient files. The primary indication for surgical treatment in the 86 patients (mean age=64 years, M/F = 40/46), included in our study, was de-facto pathological fracture (n=48), impending pathological fracture (n=29) and bone sarcoma (n=9) of the proximal femur (Table 1). In 12 patients (14%), substantial concurrent lesions of the acetabulum or the distal femur were present, requiring a more extensive surgical procedure, either acetabular reconstruction with a cemented partial pelvic replacement (n=7), (Fig. 1B), or total femur replacement (n=5). Complete data for patient survival and duration of hospital stay was available in all cases and in 83, for wound status and duration of antibiotic treatment. In four patients, who required transfer to local hospital (for social reasons, n=3) or another department within our hospital (for treatment of a cerebral abscess, n =1), in spite of modest continued wound drainage, we considered the wound dry and antibiotics discontinued on the day of discharge from our unit, to avoid inadequate overestimation of these parameters. Despite multiple operative wound revisions for continuous drainage, one patient progressed to chronic infection and was ultimately discharged to hospice on post-op day 43 on long-term antibiotics with a draining sinus. In eight cases antibiotics had to be continued after the surgical wound was dry, due to other causes: infection in the chest (n=3), gastrointestinal tract (n=2), urinary tract (n=1), brain (n=1) and one unknown primary focus. In these, antibiotics were considered discontinued the same day as the surgical wound was dry. The study was approved by the Danish Data Protection Agency (no. 2013-412591), but approval from an Ethics Committee is neither possible, nor required in our country for studies based on review of medical records only.


Persistent wound drainage after tumor resection and endoprosthetic reconstruction of the proximal femur.

Hettwer WH, Horstmann PF, Grum-Schwensen TA, Petersen MM - Open Orthop J (2014)

A: Conventional neck resection (for a pathological femoral head fracture), reconstructed with a full length (350mm), cementedstandard stem (Link SPII), to bridge metastatic involvement of the distal femur. Note screw fixation and cement augmentation for a partiallyhealed pathological fracture in the superior acetabular rim. B: Conventional calcar resection (for a pathological femoral neck fracture) andreconstruction of the proximal femur with a cemented modular revision prosthesis (Link MP). Note reconstruction and cement augmentationof a large concurrent acetabular lesion with a pelvic reconstruction cage (Link Partial Pelvic Replacement). C: Proximal femur resection(15cm), reconstructed with a long, cemented mega-prosthesis (Zimmer Segmental System) and a cemented (Link Lubinus Eccentric)acetabular component. Note screw fixation of a polyethylene anti luxation device.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300510&req=5

Figure 1: A: Conventional neck resection (for a pathological femoral head fracture), reconstructed with a full length (350mm), cementedstandard stem (Link SPII), to bridge metastatic involvement of the distal femur. Note screw fixation and cement augmentation for a partiallyhealed pathological fracture in the superior acetabular rim. B: Conventional calcar resection (for a pathological femoral neck fracture) andreconstruction of the proximal femur with a cemented modular revision prosthesis (Link MP). Note reconstruction and cement augmentationof a large concurrent acetabular lesion with a pelvic reconstruction cage (Link Partial Pelvic Replacement). C: Proximal femur resection(15cm), reconstructed with a long, cemented mega-prosthesis (Zimmer Segmental System) and a cemented (Link Lubinus Eccentric)acetabular component. Note screw fixation of a polyethylene anti luxation device.
Mentions: We retrospectively reviewed the medical records of all patients with metastatic bone disease, malignant hematologic bone disease and bone sarcoma, who underwent endoprosthetic reconstruction of the proximal femur in our specialized orthopedic oncology unit between 2010 and 2012. All relevant data (age, gender, nature and location of pathology, details of the surgical procedure, implants used, duration of antibiotic treatment, preoperative radiation therapy, hospital stay and time to a dry surgical wound) were collected from the patient files. The primary indication for surgical treatment in the 86 patients (mean age=64 years, M/F = 40/46), included in our study, was de-facto pathological fracture (n=48), impending pathological fracture (n=29) and bone sarcoma (n=9) of the proximal femur (Table 1). In 12 patients (14%), substantial concurrent lesions of the acetabulum or the distal femur were present, requiring a more extensive surgical procedure, either acetabular reconstruction with a cemented partial pelvic replacement (n=7), (Fig. 1B), or total femur replacement (n=5). Complete data for patient survival and duration of hospital stay was available in all cases and in 83, for wound status and duration of antibiotic treatment. In four patients, who required transfer to local hospital (for social reasons, n=3) or another department within our hospital (for treatment of a cerebral abscess, n =1), in spite of modest continued wound drainage, we considered the wound dry and antibiotics discontinued on the day of discharge from our unit, to avoid inadequate overestimation of these parameters. Despite multiple operative wound revisions for continuous drainage, one patient progressed to chronic infection and was ultimately discharged to hospice on post-op day 43 on long-term antibiotics with a draining sinus. In eight cases antibiotics had to be continued after the surgical wound was dry, due to other causes: infection in the chest (n=3), gastrointestinal tract (n=2), urinary tract (n=1), brain (n=1) and one unknown primary focus. In these, antibiotics were considered discontinued the same day as the surgical wound was dry. The study was approved by the Danish Data Protection Agency (no. 2013-412591), but approval from an Ethics Committee is neither possible, nor required in our country for studies based on review of medical records only.

Bottom Line: PWD for 7 days or more was observed in 41 cases (48%).The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics (mean 8.7 days) and length of hospital stay (mean 10.2 days).Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication are warranted.

View Article: PubMed Central - PubMed

Affiliation: Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.

ABSTRACT

Purpose: To examine the prevalence of prolonged wound drainage (PWD) after tumor resection and endoprosthetic reconstruction of the hip.

Methods: Retrospective review of 86 consecutive patients with metastatic bone disease, malignant hematologic bone disease or bone sarcoma, treated with tumor resection and subsequent endoprosthetic reconstruction of the proximal femur, between 2010 and 2012, in a single center.

Results: PWD for 7 days or more was observed in 41 cases (48%). The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics (mean 8.7 days) and length of hospital stay (mean 10.2 days). Total femur replacement, bone sarcoma and additional pelvic reconstruction were identified as significant independent risk factors for an even longer duration of PWD.

Conclusion: Compared to conventional hip arthroplasty, PWD appears to be significantly more prevalent in patients undergoing tumor arthroplasty procedures of the hip. Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication are warranted.

No MeSH data available.


Related in: MedlinePlus