Posts

Translate this page into:

Late Infection in Scoliosis: A Meta-Analysis

/in /by

Review Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 61-69 | Vishal Kumar, Manuj Jain, Aditya Gupta, Arvind Vatkar, Deepshikha, Sarvdeep Singh Dhatt, Sachin Kale

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.778

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 02 Oct 2025, Review Date: 20 Oct 2025, Accepted Date: 23 Nov 2025 & Published Date: 10 Dec 2025

Author: Vishal Kumar [1], Manuj Jain [4], Aditya Gupta [1], Arvind Vatkar [2], Deepshikha [3], Sarvdeep Singh Dhatt [1], Sachin Kale [5]

[1] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
[2] Department of Orthopaedics, Base Hospital, Bagdogra, West Bengal, Department of Orthopaedics,
[3] MGM Medical College, Mumbai, Maharashtra, India,
[4] Department of Physical Medicine and Rehabilitation, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
[5] Department of Orthopaedics, Dr D Y Patil School of Medicine, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Vishal Kumar,
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
E-mail: drkumarvishal@gmail.com

Abstract

This meta-analysis aims to evaluate the incidence, risk factors, and clinical outcomes of late infections in scoliosis patients following spinal instrumentation. A systematic review of studies indexed in PubMed, Embase, and Scopus databases was conducted. Studies that focused on scoliosis patients with late-developing infections, particularly after surgical treatment involving spinal instrumentation, were included. Data on infection rates, risk factors such as patient age and comorbidities, surgical techniques, and clinical outcomes were extracted and analyzed. Statistical methods, including pooled incidence rates and subgroup analysis, were used to assess the significance of the findings. The incidence of late infections varied significantly across different scoliosis types, with idiopathic scoliosis showing lower infection rates compared to neuromuscular scoliosis. Key risk factors identified included the duration of surgery, the use of prophylactic antibiotics, and patient comorbidities, particularly obesity. Late infections were often associated with a higher rate of reoperations, hardware removal, and prolonged antibiotic therapy. Late infections following spinal instrumentation in scoliosis patients remain a significant concern, with certain patient populations at higher risk. Early detection and preventive strategies are essential to mitigate these risks and improve clinical outcomes. Future research should focus on standardizing infection prevention protocols and long-term monitoring of scoliosis patients post-surgery.
Keywords: Late infection, scoliosis, spinal instrumentation, meta-analysis, risk factors, post-operative complications, neuromuscular scoliosis, idiopathic scoliosis.

References

1. Kumar V, Gupta A, Deepshikha. Late infection in scoliosis: A meta-analysis. Spine J 2024;1:11-4.
2. Clark CE, Shufflebarger HL. Late-developing infection in instrumented idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:1909-12.
3. Di Silvestre M, Bakaloudis G, Lolli F, Giacomini S. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J 2011;20 Suppl 1:S121-7.
4. Soultanis K, Mantelos G, Pagiatakis A, Soucacos PN. Late infection in patients with scoliosis treated with spinal instrumentation. Clin Orthop Relat Res 2003;411:116-23.
5. Hahn F, Zbinden R, Min K. Late implant infections caused by Propionibacterium acnes in scoliosis surgery. Eur Spine J 2005;14:783-8.
6. Richards BR, Emara KM. Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: Revisited. Spine (Phila Pa 1976) 2001;26:1990-6.
7. Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine (Phila Pa 1976) 1997;22:2444-50; discussion 2450-1.
8. Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: A multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976) 2000;25:2461-6.
9. Rihn JA, Lee JY, Ward WT. Infection after the surgical treatment of adolescent idiopathic scoliosis: Evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine (Phila Pa 1976) 2008;33:289-94.
10. Shen J, Liang J, Yu H, Qiu G, Xue X, Li Z. Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis. J Neurosurg Spine 2014;21:648-52.
11. Mackay DC, Gibson MJ. Late Wound Infection Following Posterior Scoliosis Surgery. In: Orthopaedic Proceedings. Vol. 85. The British Editorial Society of Bone & Joint Surgery; 2003. p. 198.
12. Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr., Acacio R, et al. Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: Risk factors and clinical consequences. J Bone Joint Surg Am 2014;96:e128.
13. Aleissa S, Parsons D, Grant J, Harder J, Howard J. Deep wound infection following pediatric scoliosis surgery: Incidence and analysis of risk factors. Can J Surg 2011;54:263-9.
14. Marks MC, Newton PO, Bastrom TP, Betz RR, Sponseller PD, Lonner B, et al. Surgical site infection in adolescent idiopathic scoliosis surgery. Spine Deform 2013;1:352-8.
15. Mueller FJ, Gluch H. Adolescent idiopathic scoliosis (AIS) treated with arthrodesis and posterior titanium instrumentation: 8 to 12 years follow up without late infection. Scoliosis 2009;4:16.
16. Garg S, LaGreca J, Hotchkiss M, Erickson M. Management of late (>1 y) deep infection after spinal fusion: A retrospective cohort study. J Pediatr Orthop 2015;35:266-70.
17. Cook S, Asher M, Lai SM, Shobe J. Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine (Phila Pa 1976) 2000;25:463-8.
18. Beguiristain J, Del Rio J, Duart J, Barroso J, Silva A, Villas C. Corrosion and late infection causing delayed paraparesis after spinal instrumentation. J Pediatr Orthop B 2006;15:320-3.
19. Pizones J, Sanchez-Perez-Grueso FJ, Thompson GH. Postoperative infection in early-onset scoliosis. In: The Growing Spine Management of Spinal Disorders in Young Children. Germany: Springer; 2022. p. 569-78.
20. Myung KS, Glassman DM, Tolo VT, Skaggs DL. Simple steps to minimize spine infections in adolescent idiopathic scoliosis. J Pediatr Orthop 2014;34:29-33.
21. Katyal C, Grossman S, Dworkin A, Singer L, Amaral T, Sugarman E, et al. Increased risk of infection in obese adolescents after pedicle screw instrumentation for idiopathic scoliosis. Spine Deform 2015;3:166-71.
22. Ramo BA, Roberts DW, Tuason D, McClung A, Paraison LE, Moore HG 4th, et al. Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: A thirty-year experience at a single institution. J Bone Joint Surg Am 2014;96:2038-48.
23. Kamath VH, Cheung JP, Mak KC, Wong YW, Cheung WY, Luk KD, et al. Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal. Eur Spine J 2016;25:3242-8.

How to Cite this Article: Kumar V, Jain M, Gupta A, Vatkar A, Deepshikha, Dhatt SS, Kale S. Late Infection in Scoliosis: A Meta-Analysis. Journal of Clinical Orthopaedics. July-December 2025;10(2):61-69.

 (Article Text HTML)  (Download PDF)

Translate this page into:

A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy

/in , /by

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 60-63 | Cok Gde Oka Dharmayuda, Dewa Gede Bracika, Kenji Arnaya, Sri Mahadana, Putu Teguh Aryanugraha, Benedictus Deriano, Nariswati Anggapadmi Wiraputri, I Ketut Gede Surya Pranata

DOI:10.13107/jcorth.2022.v07i01.473

Author: Cok Gde Oka Dharmayuda [1], Dewa Gede Bracika [2], Kenji Arnaya [2], Sri Mahadana [2], Putu Teguh Aryanugraha [2], Benedictus Deriano [2], Nariswati Anggapadmi Wiraputri [2], I Ketut Gede Surya Pranata [2]

[1] Consultant of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

[2] Resident of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

Address of Correspondence
Dr. Cok Gde Oka Dharmayuda,
Diponegoro St., Dauh Puri Klod, Kec. Denpasar Bar., Kota Denpasar, Bali 80113, Indonesia.
E-mail: suthenoandrew@gmail.com

Abstract

Charcot neuropathic osteoarthropathy or neuroarthropathy of the foot and ankle is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. The aim of the present study was to compare the results of EF and retrograde IMN in ankle arthrodesis for patients with Charcot neuroarthropathy of the ankle joint. This study conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Literature Search was done on using the databases of PubMed, EMBASE, and Cochrane Library were systematically retrieved. From the selected databases, 205 references were obtained. By screening the titles and abstracts, 48 references were excluded The remaining potentially relevant 12 studies underwent a detailed and comprehensive evaluation. Finally, five studies were included in our meta-analysis. Based on the report in this meta-analysis, IMN could showed better results compared to EF for Charcot joint arthrodesis, with IMN showing higher rate of fusion, and lesser risk of complication.

Keywords: Systematic Review, Meta-analysis, Charcot Neuroarthropathy, Intramedullary Nailing, External Fixation

References

  1. Yammine K, Assi C. Intramedullary nail versus external fixator for ankle arthrodesis in Charcot neuroarthropathy: A meta-analysis of comparative studies. J Orthop Surg (Hong Kong) 2019;27:1-7.
  2. Cianni L, Bocchi MB, Vitiello R, Greco T, de Marco D, Masci G, et al. Arthrodesis in the Charcot foot: A systematic review. Orthop Rev (Pavia) 2020;12 Suppl 1:8670.
  3. Dayton P, Feilmeier M, Thompson M, Whitehouse P, Reimer RA. Comparison of complications for internal and external fixation for charcot reconstruction: A systematic review. J Foot Ankle Surg 2015;54:1072-5.
  4. Almaadany FS, Samadov E, Namazov I, Jafarova S, Ramshorst GH, Pattyn P, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study. Lancet 2020;396:27-38.
  5. Devries JG, Berlet GC, Hyer CF. A retrospective comparative analysis of charcot ankle stabilization using an intramedullary rod  with or without application of circular external fixator-utilization of the retrograde arthrodesis intramedullary nail database. J  Foot Ankle Surg 2012;51:420-5.
  6. Ettinger S, Plaass C, Claassen L, Stukenborg-Colsman C, Yao D, Daniilidis K. Surgical management of charcot deformity for the  Foot and ankle-radiologic outcome after internal/external fixation. J Foot Ankle Surg 2016;55:522-8.
  7. Richman J, Cota A, Weinfeld S. Intramedullary nailing and external ring fixation for tibiotalocalcaneal arthrodesis in charcot arthropathy. Foot Ankle Int 2017;38:149-52.
  8. Elalfy B, Ali AM, Fawzy SI. Ilizarov external fixator versus retrograde intramedullary nailing for ankle joint arthrodesis in diabetic charcot neuroarthropathy. J Foot Ankle Surg 2017;56:309-13.

 

How to Cite this article: Dharmayuda CGO, Bracika DG, Arnaya K, Mahadana S, Aryanugraha PT, Deriano B, Wiraputri NA, Pranata IKGS. A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):60-63.

 (Abstract    Full Text HTML)   (Download PDF)