CORR Insights?: High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review

摘要

Prosthetic infection is the bane of limb preservation surgery and sadly is not a major focus of research. Infection rates in double-digit percentages are reported routinely, in distinction to the microscopically low rates reported for conventional reconstructive surgery. The well-recognized reasons are legion: possible immune compromise of patients with cancer, malnutrition, large bone and soft tissue defects, long operative time, frequent red blood cell and platelet transfusions, neutropenia from postoperative chemotherapy, and frequent bacteremia from the use of indwelling central venous catheters, among others. Lack of accurate data plagues the field. For example, Consumer Reports [2] and the Leapfrog Group have highlighted that major academic medical centers including the 2012-2013 US News and World Report [5] number one ranked cancer center (University of Texas MD Anderson Cancer Center, Houston, Texas, USA) and orthopaedic hospital (Hospital for Special Surgery, New York, NY, USA) do not report standards such as infection rates of central venous catheters. There is an increasing need for data and research from many expert centers if the orthopaedic oncology field is to solve this critical patient-safety issue and work toward our goal of long-term limb preservation with durable implants. Tantalizing reports of how infection may be associated with better cancer control must not divert us from our fiduciary responsibility to solve this pox on our field [4]. The large numbers of variables confound statistical analysis and defy attempts to control the contributing clinical factors. The situation calls for basic and clinical research on the topic.