Can We Save the Implant: Rib-based Implant Removal Rates and Risk Factors Following Irrigation and Debridement (I&D)...

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Biomaterials Science

Background:

• Surgical site infections (SSIs) after spinal implant surgery often necessitate debridement, but implant retention is frequently unsuccessful.
• Current literature lacks clear guidelines for managing SSIs, specifically regarding implant retention versus removal.
• This study identifies factors predicting the need for implant removal to optimize treatment strategies.

Purpose of the Study:

• To identify predictive factors for the removal of rib-based vertical expandable prosthetic titanium rib implants in early-onset scoliosis patients.
• To provide evidence-based recommendations for implant management in cases of surgical site infection.
• To reduce unnecessary implant retention attempts.

Main Methods:

• Retrospective review of early-onset scoliosis patients treated with rib-based VEPTR implants.
• Analysis of patients who developed wound complications requiring irrigation and debridement (I&D).
• Univariate and multivariate logistic regression to determine odds of implant removal, with a minimum 2-year follow-up.

Main Results:

• 32% of patients (59/181) required I&D for wound issues; 29 ultimately had implants removed.
• Predictors for removal included: total wound problems, number of I&Ds, delayed I&D, antibiotic duration, surgery count, gastrostomy tube presence, and nonambulatory status.
• Multivariate analysis identified total wound problems (OR: 6.00), delayed I&D (OR: 1.03), and gastrostomy tube (OR: 5.7) as independent predictors.

Conclusions:

• Timely debridement is crucial for successful implant retention.
• Gastrostomy tubes and a history of wound infections are significant clinical predictors for implant removal.
• These findings aid clinicians in deciding between implant retention and removal strategies for pediatric spinal instrumentation complications.