Page 107 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

to occur, there were no signi cant di erences. Twenty-three patients (26%) had a complication related to the osteosynthesis materials: broken implants (11 patients, eight of whom were under treatment for nonunion), aseptic loosening ( ve patients), pain (four patients), or malposition and instability of osteosynthesis materials (three patients).
Reoperations were performed in 61 patients (70%). Whereas reoperation rates were signi cantly lower in tibial reconstructions (p < 0.01), nail-only xation increased reoperation rates (p = 0.04). Because none of the nail-only reconstructions were free from reoperations, regression analysis was not performed.
The median time to rst complication was 14 months (0 to 66; 95% CI 9 to 19);
44% occurred in less than one year and 68% occurred in less than two years after
the index procedure. The median time to the latest complication was 32 months
(0 to 200; 95% CI 4 to 40); 24% occurred within one year after primary surgery and 5 70% occurred within four years.
Complication rates were signi cantly lower in tibial reconstructions (n = 34; p = 0.01). Nail-only xation (n = 8) was weakly associated with a higher complication risk (p = 0.09). Because all nail-only reconstructions had at least one complication, multivariable analysis could not be performed.
Infection
Although not signi cant, the infection rate was lower for femoral reconstructions (OR, 0.28) (table 2). In eight (24%) of the 34 tibial reconstructions, muscle aps were used. Of the six patients with a hybrid reconstruction, three developed infection (p < 0.01); all were adequately treated with antibiotics.
Fracture
None of the investigated factors signi cantly in uenced fracture rates. In the lower extremity, fracture risk was higher after non-bridging xation (n = 28; p = 0.05).
Nonunion
One year after primary surgery, there was lack of continuity of three cortices at the allograft-host junctions in 23 patients (26%). In two of the patients in whom the graft was considered to be incorporated on radiographs one year after primary surgery, cancellous bone grafting was performed at a later stage. In total, 35 patients (40%) with allografts required surgical intervention to facilitate the union of allograft-host junctions: ten patients underwent secondary surgery six
Intercalary allografts
105