Page 125 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Non-oncological complication rates were comparable among di erent tumor locations (p = 0.24), between reconstructions with and those without osteosynthesis (p = 0.26), among xation methods (p = 0.62), and between procedures that took place before (n = 23; 21%) and those that took place after 1995 (p = 0.84). Osteosynthesis materials were removed because of pain or irritation in seven patients (6%). Complication rates were higher after reconstructions of ≥8 cm (OR = 2.0) and increased with the extent of the cortical resection (table 2). The extent of resection retained its signi cance in multivariable analysis (table 3).
Table 2. Univariable analysis for factors of in uence on the occurrence of complications.
Inlay allografts
Complications and covariable(s)
All non-oncological complications (types I-IV) (n = 37; 33%)
25%-50% 51%-75% >75%
Mechanical: fracture of host cortex (n = 20; 18%)
25%-50% 51%-75% >75%
Nonunion of allograft-host junctions
Mechanical: nonunion of allograft-host junctions (n = 8; 7%)
Reconstruction length ≥8 cm
Non-mechanical: infection (n = 8; 7%)
Reconstruction of tibial diaphysis
>50% of cortical circumference resected
Non-mechanical: residual or recurrent tumor (n = 15; 15%*)
Inadequate margins
*Of the 97 patients with a malignant lesion.
OR 95% CI
p-value
2.9 1.2 – 6.7 0.02 <25% (reference) (1)
Reconstruction length ≥8 cm
% of cortical circumference resected
3.3 1.3 - 8.8 0.01
5.5 1.5 - 20.2 0.01 <25% (reference) (1)
Reconstruction length ≥8 cm
% of cortical circumference resected
4.1 1.1 - 15.4
9.5 1.5 - 61.1 0.02
6.9 1.4 - 33.3 0.02 9.8 1.5 - 61.7 0.02
22.0 2.6 - 186.5 9.8 2.1 - 45.3
0.005 0.004
5.9 0.7 - 49.5 0.10 4.2 1.0 - 18.0 0.06
9.8 2.1 - 45.3 14.4 4.1 - 50.8
0.004 <0.001
0.04 6
Host bone fracture was the most frequent complication (n = 20; 18%). Three of these fractures (two in the femur and one in the tibia) occurred during the index surgery and 17 (ten in the tibia, six in the femur, and one in the radius) occurred at a median of eight weeks (1 day to 5.8 years) postoperatively. Two patients (2%) had a concomitant allograft fracture. One patient (1%) had an isolated ssure fracture
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