Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padova, Italy.
Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):271-278. doi: 10.26355/eurrev_201904_17501.
Infection after orthopaedic oncology surgery is a relatively frequent complication. Infection rate ranges in the literature between 3.7% and 19.9%, increasing up to 47% after pelvic resection and reconstruction. It represents a challenging topic when occurring in oncologic patients because of the delay of systemic and local treatments, influencing prognosis. Infection is a major concern in terms of both prevention and treatment. The aim of our review was to analyze data reported in the literature about strategies and new materials for infection prevention in musculoskeletal oncology surgery.
We reviewed the literature focusing on the use of new materials that can reduce the risk of infection, avoiding biofilm formation on the implant surface.
New materials are available to try to reduce the risk of infection. Iodine-coating, DAC-coating or silver-coating, are the more promising technologies available at today. Initial results with DAC-coating in non-oncological patients are interesting; however, studies about its efficacy in preventing infection in orthopaedic oncology are not present in literature. On the other side, iodine-coating implants or silver-coating prostheses demonstrated efficacy against early infections, associated with lower risk of implant removal and amputation as final surgery.
Post-operative infections in orthopaedic oncology surgery are still frequent, and their diagnosis and treatment are demanding. According to the literature, silver-coated prostheses should be considered as the best option in case of revision surgery due to infection. However, there is no evidence that these new materials are effective to decrease the risk of infection drastically. Further studies with numerous series and long-term follow up are required.
骨科肿瘤手术后感染是一种较为常见的并发症。文献中的感染率在 3.7%至 19.9%之间，骨盆切除和重建后高达 47%。对于肿瘤患者来说，这是一个具有挑战性的问题，因为会延迟全身和局部治疗，影响预后。感染无论是在预防还是治疗方面都是一个主要关注点。我们的综述旨在分析文献中关于预防骨科肿瘤手术感染的策略和新材料的数据。
我们重点研究了可减少感染风险、避免在植入物表面形成生物膜的新材料的应用。
目前有许多新材料可用于降低感染风险。碘涂层、DAC 涂层或银涂层是目前最有前途的技术。在非肿瘤患者中，DAC 涂层的初步结果很有趣；然而，关于其在预防骨科肿瘤感染方面的有效性的研究在文献中尚未报道。另一方面，碘涂层植入物或银涂层假体在预防早期感染方面具有疗效，与较低的植入物移除和截肢风险相关。
骨科肿瘤手术后的感染仍然很常见，其诊断和治疗具有挑战性。根据文献，在因感染而进行翻修手术时，应考虑使用银涂层假体作为最佳选择。然而，尚无证据表明这些新材料能有效地显著降低感染风险。需要进行更多具有大量系列和长期随访的研究。
