Musculoskeletal Infection in Orthopaedic Oncology

Background: The first International Consensus Meeting (ICM) on Musculoskeletal Infection convened in 2013 in order to provide agreement on the prevention, the diagnosis, and the treatment of surgical site infection (SSI) and periprosthetic joint infection (PJI). Recognizing the added susceptibility of orthopaedic oncology patients to SSI and PJI, the second ICM in 2018 included questions and corresponding recommendations from this subspecialty of orthopaedics. Methods: The 13 steps of the Delphi method were followed over the course of 26 months, starting in June 2016. From July 25 to 27, 2018, delegates from 93 countries convened at Thomas Jefferson University in Philadelphia, Pennsylvania. Delegates were divided into their subspecialty workgroups, where questions and recommendations were discussed, modified, and subsequently voted upon. The level of consensus measured the agreement among the delegates on the basis of the voting results. The level of evidence that accompanied each question and recommendation was dependent on the types of studies that were reviewed for each question and the number of flaws that were present in those studies. Results: There were 30 orthopaedic oncology questions and recommendations that were voted on by 14 delegates with expertise in either orthopaedic oncology or infectious disease. Twenty-six (87%) of the questions were unanimous among the delegates. The remaining 13% (n = 4) were agreed upon by 93% of the delegates, with 7% of the delegates abstaining from the vote. Conclusions: The inclusion of orthopaedic oncology in the 2018 ICM on Musculoskeletal Infection was particularly important because of the high rate of SSI and PJI following these procedures. Despite there being strong consensus among voting delegates, these recommendations are based on limited levels of evidence and tend to reflect the recommendations from hip and knee arthroplasty. We hope that high-quality prospective studies in the field of orthopaedic oncology are available for the third ICM.