title: High complication rate after septic orthopaedic implant removal of the lower leg.
abstract: BACKGROUND
  The aim of the study was to determine predictive risk factors for revision surgery in patients with septic orthopaedic implant removal of the lower leg.
  
  
  METHODS
  A total of 196 patients with septic removal of orthopaedic implants after primary trauma of the lower leg between 2008 and 2012 were evaluated. Patients with endoprosthesis infection were excluded from this study.
  
  
  RESULTS
  Thirteen patients (22.4 %) had infectious complications with revision surgery. We found 14 patients with soft tissue infections, 10 patients with osteomyelitis, 19 patients with wound-healing problems, 10 patients with pin track infections and two patients with fistulas. High complication rates were associated with severity of the initial trauma, localisation, and the state of union or non-union. Patients with peripheral arterial disease, anaemia and smoking showed a significantly higher risk for revision surgery; whereas patients with diabetes and arterial hypertension did not. A total of 22.6 % had open fractures as an initial trauma. In 76 %, bacteria could be detected. The complication rate was 41.2 % after initial open fractures and 19.6 % after initial closed fractures. A higher grade of soft tissue damage showed no increasing complication rate (p > 0.05).
  
  
  CONCLUSIONS
  In this study, complications after septic implant removal of the lower leg were evaluated and risk factors were determined. The awareness of the risks for complications after septic orthopaedic implant removal can lead to a better treatment for patients. Decision-making can be based on scientific results to prevent patients suffering from further severe disease progression.
authors.affiliation: Department for Septic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen, Germany, arnoldsuda@yahoo.com.
authors.forename: A J
authors.initials: AJ
authors.lastname: Suda
authors.forename: K A
authors.initials: KA
authors.lastname: Winkler
authors.forename: P A
authors.initials: PA
authors.lastname: Grützner
authors.forename: P C
authors.initials: PC
authors.lastname: Thoele
authors.forename: V G
authors.initials: VG
authors.lastname: Heppert
authors.forename: J
authors.initials: J
authors.lastname: Franke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005360:Fibula / Q000293:injuries*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D005596:Fractures, Closed / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*