Page 104 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 5
Table 1. Study data
Variable
Three Four Five Eight
Type of complication Infection
Fracture
Nonunion
Associated with osteosynthesis materials
Reoperation Failure
Total number of removed allografts
Allograft-related failures Duration of follow-up
Five years or more Ten years or more
All localizations* (n = 87)
9 (10) 5 (6) 2 (2) 1 (1)
12 (14) 25 (29) 35 (40) 23 (26) 61 (70)
15 (17) 13 (15)
57 (66) 29 (33)
Lower extremity* (n = 78)
8 (10) 4 (5) 2 (3) 1 (1)
8 (10) 23 (30) 29 (37) 22 (25) 53 (68)
10 (13) 9 (12)
51 (65) 23 (29)
*The values are given as the number of patients, with the percentage in parentheses.
†The osteosynthesis with plates occurred with or without addition of bular strut grafts and/or screws.
Results
Incidence of and Risk Factors for Failure
During follow-up, 15 patients (17%) had allografts removed, including 13 patients who had allografts removed because of graft-related complications (nine patients with complications in the femur and four patients with complications in the humerus) and two patients who had local recurrences and underwent ablative surgery (one patient underwent rotationplasty and one patient underwent amputation). The reasons for graft-related failures were fracture (n = 5), infection (n = 4), and nonunion (n = 4). Of the graft-related failures, 12 occurred in the rst four years after the index surgery. Three patients had late failures due to nonunion after six years, fracture after 11 years, and infection after 15 years. None of the graft- related failures necessitated ablative surgery; limb salvage was achieved in 98% of patients.
There were no signi cant di erences in allograft survival or complication rates for patients who underwent operations in the late 1980s and early 1990s (n = 31 [36%]), compared with those whose primary surgery took place after 1995.
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