Page 105 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Infection increased the risk of failure (n = 12; p = 0.02), and weak trends were seen for fracture (n = 25; p = 0.09) and nonunion (n = 35; p = 0.09). Failure rates were signi cantly higher in patients who were 18 years of age and older (n = 43; p < 0.01), in patients with reconstruction sites other than the tibia (n = 53; p < 0.01), and in patients undergoing diaphyseal reconstructions (n = 43; p = 0.04).
Failure rates for lower-extremity reconstructions were signi cantly higher in
patients who were 18 years of age and older (n = 43; OR, 11.03; p = 0.03) and in
patients undergoing reconstructions with an allograft of ≥15 cm in length (n =
39; OR, 10.40; p = 0.03) (table 2). In multivariable analyses, patients who were 18
years of age and older (n = 43) demonstrated higher failure rates, independent
of diaphyseal localization (OR, 6.23) and reconstruction length ≥15 cm (OR, 6.15)
(table 3). Because none of the tibial reconstructions failed, reconstruction site was
excluded from regression analysis. 5
Table 2. Univariate logistic regression analysis for the risk of failure, infection, and nonunion.
Complications and covariates
Failure†
Patient age of ≥18 years
Allograft length of ≥15.0 cm
Localization within bone piece: diaphyseal
Infection‡
Localization: femur Osteosynthesis: bridging plate(s) Osteosynthesis: plates§
Nonunion# Localization: tibia
Osteosynthesis: intramedullary nail only
Patient age of ≥14 years Allograft length of ≥10.0 cm
Odds ratio*
7.22 (1.49 - 34.88) 3.30 (0.93 - 11.70) -
0.28 (0.07 - 1.10) 0.26 (0.05 - 1.24) 0.34 (0.09 - 1.18)
0.37 (0.15 - 0.95) 5.17 (0.98 - 27.32)
-
3.93 (0.81 - 19.17)
p-value Odds ratio*
p-value
Intercalary allografts
All localizations Lower extremity
0.01 11.03 (1.31 - 93.14) 0.03 0.07 10.40 (1.23 - 87.75) 0.03 - 4.29 (0.83 - 22.15) 0.08
0.07 - - 0.09 - - 0.09 - -
0.04 - - 0.05 4.90 (0.88 - 27.12) 0.07
- 2.64 (0.91 - 7.66) 0.07 0.09 --
*The values are given as the odds ratio, with the 95% CI in parentheses. †There were thirteen patients who had failure in all locations and nine patients who had failure in the lower extremity. ‡There were twelve patients who had infection in all locations and eight patients who had infection in the lower extremity. §The osteosynthesis with plates occurred with or without addition of bular strut grafts and/or screws. #There were thirty- ve patients who had nonunion in all locations and twenty-nine patients who had nonunion in the lower extremity.
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