Bone anchor infections in female pelvic reconstructive procedures: A literature review of series and case reports

Purpose: We determined the reported prevalence of infectious osseous compli cations due to the use of bone anchors for suture fixation in female pelvic reconstructive procedures. In addition, the type and method of bone anchor s as well as the reported pathogens associated with osseous infections were reviewed. Materials and Methods: Primary reported series of female pelvic reconstruct ive procedures involving bone anchor suture fixation referenced in Index Me dicus from January 1990 to July 2000 were extracted using the MEDLINE bibli ographic database on English language articles involving humans. All case r eports of infectious osseous complications due to bone anchor use in female reconstructive procedures were also reviewed during this period. Results: Since the inception of bone anchor suture fixation for female pelv ic reconstructive procedures 10 years ago, the overall prevalence of relate d infectious complications has been 6 cases in 1,018 procedures (0.6%). Thi s type of adverse event developed between followup weeks 1 and 24. The prev alence of suprapubic bone anchors has been 6 cases in 698 procedures (0.86% ). For transvaginal bone anchor procedures no infectious cases have been re ported in the combined series of 314 procedures and the same is true for 1 reported case of sacral bone anchor placement in 6 procedures. No statistic al difference was noted in regard to the prevalence of infection in procedu res involving suprapubic bone anchors and transvaginal bone anchor combined with sacral bone anchor placement (Fisher's exact test p = 0.19). The orga nisms reported in case reports suggest a coliform, skin or hematogenous sou rce for contamination of the bone anchor site. Conclusions: An infectious bone anchor complication in female pelvic recons tructive procedures is an uncommon event with a reported prevalence of 0.6% . Currently there is no evidence of differences in the prevalence of osseou s complications after transvaginal versus suprapubic bone anchor fixation. Preoperative broad-spectrum antibiotics are recommended to decrease the pot ential of infectious bone anchor complications.