Page 108 - Reconstructive Techniques in Musculoskeletal Tumor Surgery
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Chapter 5
to 12 months after the initial surgery, and the remaining 25 patients underwent secondary surgery more than a year after the initial surgery.
In univariable analysis, tibial localization (OR, 0.37) decreased the nonunion risk, but nail-only xation (OR, 5.17) and allograft length of ≥10 cm (OR, 3.93) both showed trends toward higher nonunion rates (table 2). In multivariable analysis, nail-only xation (OR, 7.30) and tibial localization (OR, 0.33) were of signi cance (table 3).
Time to Full Weight-Bearing
The median time to full weight-bearing was nine months (1 to 81, 95% CI 7.5 to 10.5). Because there were missing data in 37% of relevant patients, a comparison between groups was not performed.
Table 3. Multivariate logistic regression analysis for the risk of failure and nonunion
Complications and covariates
Failure†
First analysis
Patient age of ≥18 years
Allograft length of ≥15.0 cm Second analysis
Patient age of ≥18 years
Localization within bone piece: diaphyseal
Nonunion# Localization: tibia
Osteosynthesis: intramedullary nail only
Allograft length of ≥10.0 cm
Odds ratio*
p-value
All localizations
Odds ratio* p-value
6.15 (1.25 - 30.34) 0.03 2.51 (0.67 - 9.36) 0.01
6.23 (1.24 - 31.34) 0.03 1.68 (0.44 - 6.42) 0.45
0.33 (0.12 - 0.91) 0.03 7.30 (1.16 - 45.69) 0.03
3.81 (0.74 - 19.72) 0.11
Lower extremity
8.04 (0.92 - 70.53) 0.06 7.47 (0.85 - 65.75) 0.07
8.57 (0.98 - 75.19) 0.05 2.66 (0.48 - 14.76) 0.26
0.38 (0.14 - 1.08) 0.07 6.66 (1.05 - 42.22) 0.04
2.97 (0.56 - 15.76) 0.20
*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 thirty- ve patients who had nonunion in all locations and twenty-nine patients who had nonunion in the lower extremity.
Discussion
We evaluated (1) incidence of and risk factors for failure, (2) incidence of and risk factors for complications, (3) time to full weight-bearing, and (4) optimal xation methods for intercalary allografts after tumor resection. Judging from the literature,
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