Page 110 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 5
unfavorable results might be explained by the smaller contact surface of these junctions, as compared with metaphyseal and epiphyseal junctions. However, other studies found no di erences or even a higher rate of delayed union for osteotomy lines placed in metaphyseal cancellous bone20,31.
Nonunion rates vary greatly throughout literature (15% to 55%)13,14,16-19,32- 34. Whereas some studies assess nonunion per patient, others consider both osteotomy lines and thus score more nonunions. In a large prior study, nonunion was de ned as the lack of continuity in three cortices at the junctional site one year after surgery20. Whereas 47% of patients in that study matched this de nition, only 26% of patients in our study did. We chose to report on nonunion in a second way: if additional surgery was performed to facilitate union, taking place at least six months after implantation of the graft. Forty percent of our patients matched this de nition. Previous large series have shown reoperation rates for nonunion ranging from 15% to 28%13,15,20.
The overall complication rate in our study was high compared with those in previous series, which showed complication rates ranging from 42% to 46% (see appendix). However, this rate appears to be related to those complications that were tracked, rather than a di erence in the incidence of major complications (infection, fracture, and nonunion).
Whereas adverse e ects of adjuvant treatment have been described in the literature20,29, we were not able to identify any unfavorable associations for adjuvant chemotherapy or irradiation.
Fracture and infection rates in our population were high, but comparable with previously reported rates14,15,20,35,36. Because of the retrospective character of this study, we were unable to retrieve all data on the time to full weight-bearing and, thus, conclusions must be made with caution. Nevertheless, partial and non- weight-bearing periods were considerable in our patients. Authors in previous studies have not reported time to full weight-bearing13-15,20.
Our study had additional limitations. Although follow-up in our study is among the longest reported on intercalary allografts (see appendix), there is a possibility of underestimating real complication percentages, as there are considerable percentages of late complications. Also, we were unable to acquire functional outcome.
In conclusion, we found high rates of complications leading to reoperations. The majority of complications occurred in the rst two years after implantation. Even though complication rates were high, the graft survival rate was 83% and
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