Page 84 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 4
with open reduction and reinforced with an attachment tube. The proportion of patients who experienced a dislocation was comparable between patients who had type 2 ( ve of 21 [24%]) and type 2–3 ( ve of 26 [19%]) resections (odds ratio [OR], 0.76; 95% CI, 0.19– 3.09; p = 0.703). With the numbers we had we could not detect a di erence in dislocation in those who had reconstructions with (two of 16 [13%]) or without (eight of 31 [26%]) attachment tubes (OR, 0.41; 95% CI, 0.08 – 2.22; p = 0.301). The risk of dislocation was lower for patients with a dual- mobility cup (one of 24 [4%]) compared with those without (nine of 23 [39%]); consequently, dislocation-free survival was signi cantly better (HR, 0.11; 95% CI, 0.01 – 0.89; p = 0.038).
Aseptic loosening (Henderson type II) occurred in three reconstructions (6%). Loosening occurred in two cases with an uncemented stem (one, 57 months after xation in a structural pelvic allograft that had failed as a result of allograft resorption; and one, 36 months after implantation with an intraoperative fracture, which had caused insu cient primary xation) and in one with a cemented stem.
Structural complications (Henderson type III) occurred in four patients (9%); two had periprosthetic iliac fractures (one treated conservatively with a good result, one was removed as a result of infection), two had a fracture during implantation (one is discussed previously, the fracture was treated conservatively and later failed as a result of implant loosening; one was xed with non-absorbable sutures – the stem penetrated the iliac cortex 7 days later, for which re- xation was performed; no further complications occurred). Structural failure of the implant itself was not observed.
A total of 38% (18 of 47) of our patients experienced one or more non- mechanical complications. Deep infections (Henderson type IV) occurred in 13 patients (28%), 10 within 2 months, two after 3 months, and one after 34 months. Nine were successfully treated with surgical debridement and intravenous antibiotics. In four patients (10%; two with previous surgery – one THP, one pedestal cup), the implant was removed (three within one month, one after 34 months). At review, two of these patients were left ail without reconstruction and a hindquarter amputation, a type BII rotationplasty24 and a second LUMiC were performed in one each. Median duration of surgery was 6.5 hours (range, 4.0 – 13.6 hours) for patients with an infection and 5.3 hours (range, 2.8 – 9.9 hours) for those without (p = 0.060). Blood loss showed a statistically signi cant correlation with the risk of infection; blood loss was 2.3 L (range, 0.8 – 8.2 L) for patients with an infection and 1.5 L (range, 0.4 – 3.8 L) for those without (p = 0.039). Other factors
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