Page 121 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

diagnosed on images or intraoperatively. A patient was considered to have had an infection if any surgical procedure had been done to treat a deep infectious process around the allograft. Allografts that were partially or completely removed for any reason were de ned as failures. The presence of residual or recurrent tumor and metastases was assessed on radiographic images, and on pathology reports if surgery was performed. Before 2006, routine radiographic follow-up was done with conventional radiographs and MRI was performed when recurrence was suspected. From 2006 onward, malignant lesions were followed according to national guidelines that included MRI at one, two, ve, and ten years.
Student t tests and Mann-Whitney U tests were used to compare continuous
variables between groups. Kaplan-Meier curves were used to estimate construct
survival. Logistic and Cox regression analyses were performed to assess factors
of in uence on the occurrence of complications and time to failure. Outcomes
are expressed with the odds ratio and hazard ratio (OR and HR), 95% con dence
interval (95% CI), and p-value. A 5% level of signi cance was used in the analyses. 6
Results
We included 111 patients (44 males; 40%) with a median age of 28 years (7 to 73) at surgery (table 1). Ninety (81%) were treated at one center and seven (6%) were treated at each of the other centers. The resected specimen revealed a diagnosis other than a neoplasm in three patients (3%) — reactive bone and cartilage formation in two and bizarre parosteal osteochondromatous proliferation in one — all of whom had been suspected of having parosteal osteosarcoma preoperatively. Eleven patients (10%) had a benign tumor and 97 had a malignant tumor, which was low-grade in 61 (55%), intermediate-grade in 22 (20%), and high-grade in 14 (13%). The predominant diagnoses were adamantinoma (n = 37; 33%) and parosteal osteosarcoma (n = 18; 16%). Computer-assisted navigation was used in ve patients (5%). Twelve patients (11%) received chemotherapy, and six (5%) underwent radiation therapy.
At the time of the review, 104 patients (94%) were alive after a median duration of follow-up of 6.7 years (2 to 23). Seven patients (6%) had died during the follow- up period, at a median of 26 months (7 months to 6.4 years) postoperatively. Six of these deaths were due to disease (two Ewing sarcomas, two grade 2 chondrosarcomas, one osteosarcoma, and one periosteal osteosarcoma).
Inlay allografts
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