Surgical Site Infections Following Pelvic Sarcoma Reconstruction with 3D-Printed Implants: Current Concepts and Future Directions.

Abstract

Introduction: Surgical site infections (SSIs) are a major complication following pelvic sarcoma reconstruction using 3D-printed implants. Despite advances in anatomical matching and biomechanics, infection rates remain significantly higher than in conventional arthroplasty.To review and synthesize current evidence (2010-2025) on the incidence, microbiological characteristics, risk factors, prevention strategies, and treatment approaches of SSIs in patients undergoing pelvic reconstruction with 3D-printed implants. Methods: A narrative literature review was conducted using PubMed, MEDLINE, Scopus, and Web of Science databases. Studies focusing on pelvic reconstructions with 3D-printed implants and reporting infection outcomes were included. A total of 56 studies were selected after applying inclusion and exclusion criteria. Results: SSIs in 3D-printed pelvic reconstructions exhibit a high incidence (5-40%) and a unique polymicrobial, gram-negative-dominated microbiological profile. Key risk factors include extensive surgical resection, prolonged operative time, prior radiotherapy, and compromised immune status. Titanium alloy (Ti6Al4V) remains the standard material, although it poses infection risks due to bioinert properties. Preventive measures such as antibacterial coatings, improved surgical techniques, and high-pressure lavage are increasingly used. Treatment involves surgical debridement, targeted antibiotics, and in some cases, implant revision or removal. Conclusion: SSIs represent a critical barrier in optimizing outcomes for pelvic sarcoma reconstruction with 3D-printed implants. A multidisciplinary approach integrating surgical innovation, materials science, and infection control is essential. Further research is needed on antimicrobial technologies and long-term outcomes.