Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated with United Fractures Does Not Increase Recurrence Risk

Abstract

OBJECTIVES: To evaluate if retention of antibiotic cement delivery devices after resolution of orthopedic infection is associated with recurrence. METHODS: Design: Retrospective Cohort Setting: Academic Medical Center Patient Selection Criteria: Patients with a fracture definitively treated with internal fixation that went on to unite and developed a confirmed fracture-related infection or osteomyelitis following a remote fracture surgery, and had implantation of antibiotic-impregnated cement for infection management. Outcome Measures and Comparisons: Patients were divided into whom the antibiotic implants were retained (Retained Cohort), and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included: clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, need for soft tissue coverage (local flap vs free tissue transfer) due to recurrence. RESULTS: Of 98 patients treated for FRI in united fractures or osteomyelitis following a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([ASA Score, p=0.026] and [Diabetes, p=0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, p=0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms and laboratory values (p=0.360). There was no difference in incidence of subsequent infection recurrence following clinical infection resolution (1 recurrence Retained vs 2 recurrences Removed, p=0.605) for those considered “cured”. Compared to the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs 1.84 reoperations, p<0.001) and admissions following implantation (p<0.001). CONCLUSIONS: Retention of antibiotic-impregnated cement delivery devices in patients with orthopedic infection following fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted.