Infection in bone allografts. Incidence, nature, and treatment.

Lord, C F; Gebhardt, Mark C.; Tomford, W W; Mankin, Henry J.

doi:10.2106/00004623-198870030-00008

Cited by 436 publications

(221 citation statements)

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“…The infection frequency in this series was 9% (60 infections in 673 patients) and is similar to previous reports [2,4,6,7,10,12,13]. Lord et al [6] reported a 11.7% infection rate (33 infections in 283 patients); their series did not differ with regard to age, sex, type of allograft, or site of the allograft.…”

Section: Discussionsupporting

confidence: 90%

“…In the present series, 18% of the infected patients (11 of 60 patients) were successfully treated with surgical débride-ment and antibiotics without removal of the allograft, and the percent is similar to other reports (Lord et al 14% [6] and Loty et al 14% [7]). Of the 49 patients (82%, 49 of 60 infections), in which the allograft was removed and a temporary cement spacer with antibiotic was implanted to control the infection, only 41 were secondary reconstructed (68%, 41 of 60 infected patients) with another bone allograft in 24 and an endoprosthesis in 17.…”

Section: Discussionsupporting

confidence: 89%

“…Lord et al [6] reported a 11.7% infection rate (33 infections in 283 patients); their series did not differ with regard to age, sex, type of allograft, or site of the allograft. Dick and Strauch [2] reported a 13.3% infection rate (10 infections in 75 patients) and chemotherapy was not found to be a predisposing factor to infection when compared with the overall group.…”

Section: Discussionmentioning

confidence: 85%

“…Infection is a major cause of failure in this type of reconstruction; however, there is no general consensus regarding the management of this complication and few studies provide the results of infection treatment in massive bone allografts [2,4,6,7,10]. Although many papers that analyzed allograft reconstructions described the frequency of infection [1,3,8,9,13], only a few papers analyzed the management of this complication [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Although many papers that analyzed allograft reconstructions described the frequency of infection [1,3,8,9,13], only a few papers analyzed the management of this complication [2,6,7]. Those reports that have analyzed the frequency and treatment of bone allograft infections [2,6,7] did not provide the likelihood of reinfection. For that reason, we sought to analyze the frequency infection and the likelihood of its eradication using a variety of approaches at one institution in a group of patients with bone tumors who underwent massive bone allografts.…”

Section: Introductionmentioning

confidence: 99%

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What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Aponte-Tinao

Ayerza

Múscolo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important. Questions/purposes The purposes of this study were (1) to analyze the frequency of infection in a group of patients treated with massive bone allografts; (2) to analyze risk factors such as age, sex, affected bone, type of reconstruction, operative room used, primary or revision procedure, length of postoperative antibiotic administration, and use of chemotherapy; and (3) to determine the likelihood that treatment of an infected allograft will result in a successful reconstruction.Methods We retrospectively analyzed the records of patients treated with massive bone allografts for a benign or malignant bone tumor or as a revision for a previous limb salvage procedure between 1985 and 2011. During this period, 673 patients were reconstructed with massive bone allografts in long bones, which included 272 osteoarticular, 246 intercalary, and 155 allograft-prosthetic composite reconstructions. Using a chart review, we ascertained the frequency of infection and reoperations after the treatment of infected allografts. Minimum followup was 2 years unless death occurred earlier (mean, 106 months; range, 6-360 months), and no patient was lost to followup. The selected variables were analyzed using multivariate logistic regression to identify risk factors for infection. We analyzed survivorship free of infection as the endpoint. Results During followup, 60 patients (9%) had a bacterial infection of the allograft with a survivorship free from infection of 92% at 5 years (95% confidence interval [CI], 90%-94%) and 91% at 10 years (95% CI, 89%-93%). We found that tibia allografts (p\0.001; odds ratio [OR], 3.17; 95% CI, 1.80-5.60), male patients (p \ 0.029; OR, 1.92; 95% CI, 1.08-3.49), procedures performed in a conventional operating room (p \ 0.002; OR, 3.15; 95% CI, 1.58-6.62), and the use of longer periods of postoperative antibiotics (p \ 0.041; OR, 2.25; 95% CI, 1.02-4.88) were patient factors associated with a greater risk of infection. In 11 patients (18%, 11 of 60 infections) the infection was controlled with antibiotics and surgical débridement; however, in 49 patients (82%, 49 of 60 infections), this approach failed, so the allograft was removed and a temporary cement spacer with antibiotic was implanted to control the infection. Forty-one patients subsequently had the spacer removed and were reconstructed after infection control with another bone allograft in 24 and an endoprostheses in 17. Four patients underwent an amputation

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Aponte-Tinao

Ayerza

Múscolo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Analysis of variables affecting wound healing after musculoskeletal sarcoma resections

Chmell

Schwartz

1996

J. Surg. Oncol.

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Kinetics of cortical bone demineralization: Controlled demineralization?a new method for modifying cortical bone allografts

Lewandrowski¹,

Venugopalan²,

Tomford³

et al. 1996

J. Biomed. Mater. Res.

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We investigated the kinetics of hydrochloric acid demineralization of human cortical bone with the objective of developing a method of controlled demineralization for structural bone allografts. It is known that the demineralization of cortical bone is a diffusion rate limited process with a sharp advancing reaction front. The demineralization kinetics of human cortical bone, described as the advance of the reaction front versus immersion time, were determined by measuring extraction of bone mineral in both planar and cylindrical geometries. Mathematical models based on diffusional mass transfer were developed to predict this process. The experimental data fit well with the behavior predicted by the model. The model for planar geometry is applicable to controlled demineralization of cortical bone allografts of irregular shapes such as cortical struts. The model for cylindrical geometry is appropriate when curved surfaces are involved such as in diaphyseal bone allografts. This method of demineralization has direct application to clinical modification of cortical bone allografts to potentially enhance their osteoinductive properties.

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Infection in bone allografts. Incidence, nature, and treatment.

Cited by 436 publications

References 0 publications

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Analysis of variables affecting wound healing after musculoskeletal sarcoma resections

Kinetics of cortical bone demineralization: Controlled demineralization?a new method for modifying cortical bone allografts

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