title: Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution.
abstract: BACKGROUND
  Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications.
  
  
  OBJECTIVE
  We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy.
  
  
  METHODS
  From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection. Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter.
  
  
  RESULTS
  A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection. Despite surgical débridements and antibiotics, 16 patients (46%) had the implant removed and five (9%) underwent external hemipelvectomy (four owing to infection and one as a result of persistent infection and local recurrence).
  
  
  CONCLUSIONS
  Infection is a common complication of pelvic resection for bone tumors. Reconstruction after resection is associated with an increased risk of infection compared with resection alone, without significant difference in percentage between allograft and metallic prosthesis. When infection occurs, it requires removal of the implant in nearly half of the patients who have this complication develop, and external hemipelvectomy sometimes is needed to eradicate the infection.
authors: III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, (BO), Italy.
authors: Andrea
authors: A
authors: Angelini
authors: Gabriele
authors: G
authors: Drago
authors: Giulia
authors: G
authors: Trovarelli
authors: Teresa
authors: T
authors: Calabrò
authors: Pietro
authors: P
authors: Ruggieri
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006428:Hemipelvectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology*; D016896:Treatment Outcome
references: Cancer. 1996 Aug 15;78(4):745-50
references: 8756367
references: J Surg Oncol. 2010 Feb 1;101(2):160-5
references: 19960486
references: J Bone Joint Surg Br. 2005 Nov;87(11):1527-30
references: 16260673
references: Clin Orthop Relat Res. 2002 Mar;(396):197-205
references: 11859244
references: Eur J Surg Oncol. 1997 Dec;23(6):540-6
references: 9484927
references: J Bone Joint Surg Am. 2009 Jan;91(1):142-51
references: 19122089
references: J Surg Oncol. 2011 Mar 1;103(3):269-75
references: 21337556
references: Arch Orthop Trauma Surg. 1987;106(2):71-7
references: 3566509
references: Cancer. 1993 May 15;71(10 Suppl):3358-66
references: 8490883
references: J Orthop Sci. 2000;5(3):198-204
references: 10982657
references: Clin Orthop Relat Res. 2001 Jul;(388):178-86
references: 11451117
references: Ann Surg Oncol. 2008 Jan;15(1):355-63
references: 17955297
references: J Bone Joint Surg Am. 2007 Mar;89(3):579-87
references: 17332107
references: Arch Orthop Trauma Surg. 2003 Sep;123(7):340-4
references: 12838435
references: J Bone Joint Surg Am. 1978 Sep;60(6):731-46
references: 701308
references: Int Semin Surg Oncol. 2005 Apr 09;2(1):9
references: 15819994
references: J Surg Oncol. 2003 Jul;83(3):154-60
references: 12827683
references: Clin Orthop Relat Res. 2002 Sep;(402):220-35
references: 12218488
references: Orthop Clin North Am. 1991 Jan;22(1):65-86
references: 1992435
references: J Bone Joint Surg Br. 2006 Sep;88(9):1121-36
references: 16943459
references: Clin Orthop Relat Res. 1983 Apr;(174):69-86
references: 6339144
references: Orthopedics. 2012 Feb 17;35(2):e232-43
references: 22310412
references: Acta Orthop Scand. 1999 Aug;70(4):348-52
references: 10569264
references: Clin Orthop Relat Res. 2011 May;469(5):1450-8
references: 21312077
references: Clin Orthop Relat Res. 1997 Apr;(337):226-39
references: 9137194
references: Surg Oncol. 2010 Jun;19(2):95-105
references: 19467585
references: Eur J Surg Oncol. 2004 Oct;30(8):893-9
references: 15336737
references: Clin Orthop Relat Res. 2003 Apr;(409):209-17
references: 12671504
references: Clin Orthop Surg. 2010 Sep;2(3):160-6
references: 20808587
references: J Bone Joint Surg Am. 1992 Mar;74(3):331-41
references: 1548259
references: Clin Orthop Relat Res. 2005 Sep;438:36-41
references: 16131867
references: Orthop Traumatol Surg Res. 2012 May;98(3):309-18
references: 22463866
references: Clin Orthop Relat Res. 1995 May;(314):203-13
references: 7634637
references: Clin Orthop Relat Res. 1994 Jul;(304):207-17
references: 8020218
references: Clin Orthop Relat Res. 1998 May;(350):187-94
references: 9602819
references: Clin Orthop Relat Res. 1996 Oct;(331):265-76
references: 8895649
references: J Surg Oncol. 2012 Sep 15;106(4):406-10
references: 22371155
references: J Surg Oncol. 2012 Sep 15;106(4):417-22
references: 22457213
references: Clin Orthop Relat Res. 2001 Sep;(390):190-205
references: 11550866
references: J Bone Joint Surg Am. 1997 Nov;79(11):1663-74
references: 9384426
references: J Surg Oncol. 2012 Dec;106(8):929-37
references: 22649023
references: J Bone Joint Surg Br. 1990 May;72(3):490-3
references: 2341454
references: J Surg Oncol. 2001 Oct;78(2):90-100
references: 11579386
references: J Bone Joint Surg Br. 1997 Sep;79(5):773-9
references: 9331034
references: Clin Orthop Relat Res. 2007 Aug;461:180-8
references: 17452921
references: Acta Orthop Scand. 1996 Aug;67(4):333-8
references: 8792734
references: J Bone Joint Surg Br. 2008 Sep;90(9):1222-7
references: 18757964
references: Clin Orthop Relat Res. 2005 Sep;438:30-5
references: 16131866