Infection in massive bone allografts sterilised by radiation

Abstract

Massive bone allografts sterilised by radiation have been used in our hospital since 1985. The 164 consecutive reconstructions which we carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects. The allografts were used as intercalary or composite graft-prosthesis reconstructions. Fourteen (8.5%) skin sloughs or infections occurred, all but one after operations for malignant tumours. The grafts never appeared to be responsible. Infection after malignant tumour resection most commonly occurred at the knee when preoperative radiation had been used. Twenty-five reconstructions were performed in the presence of infection, which only recurred in one case. Twelve infections were treated, but 2 other patients died for other reasons within a year. One patient had to have an amputation and one had persistent infection. In the other cases, the infection healed. Only two debridements alone were successful. Removal of the graft and replacement with antibiotic-loaded cement was the most effective treatment.

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

“…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.…”

“…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.…”

“…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. Loty et al [7] reported 14 infections (8.5%) in 164 patients reconstructed with massive bone irradiated allografts and they did not find chemotherapy to be a risk factor.…”

“…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].…”

“…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.…”