The life expectancy of patients with bone metastases has remarkably increased over recent years leading to higher incidence of bone metastases with major risk of pathological fractures and orthopedic treatments. Orthopedic surgery in bone metastases has a highly diversified approach and could be very invasive, requiring prosthetic implants, allograft, nails, plates or other metallic devices, vascular procedures, and plastic surgery.
Metal wear and especially megaprosthesis implantation are commonly complicated by deep infections, which are probably the most common and severe complication in orthopedic oncological surgery, considered as challenging as local relapse. The rate of infection in these treatments range from 8% to over 40%, with great variability depending on the site of replacement, age, comorbidity, resection size, and histological characteristics of primary malignant tumor involved.
Infection prevention is therefore of the utmost importance considering that, when there are poor soft tissue conditions, secondary amputation is sometimes inevitable.
Postoperative infection complications have also a heavy impact on the cost and management aspects due to hospital readmissions, extended hospitalization, the need for additional procedures, and convalescent or nursing home care.
Great interest is actually spreading about orthopedic infections in bone metastatic disease, as reflected by a great number of literature reviews, monothematic meetings, and multicenter prospective studies. According to this consideration, in this chapter we analyze all the possible actions described to prevent and treat surgical site infections following this kind of surgery, including an appropriate antibiotic prophylaxis, surgical procedures for primary and revision surgery and recent technical improvements.
Infection Limb salvage surgery Tumor prosthesis Antibiotic prophylaxis
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