Page 85 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

we analyzed (attachment tubes, silver-coated cups) were not correlated to the risk of infection.
Local recurrence (Henderson type V) occurred in six patients (13%; four chondrosarcomas, one clear cell chondrosarcoma, and one phosphaturic mesenchymal tumor; the latter two had tumor spill during the index procedure) after a median of 22 months (range, 10 months to 4.5 years). Five were treated with construct-sparing resections and one patient had an extensive periprosthetic recurrence; no further surgery was undertaken because of a poor prognosis. Four of 41 primary tumors metastasized (10%).
The cumulative incidences of implant failure at two and ve years were 2.1% 4 (95% CI, 0 – 6.3) and 17.3% (95% CI, 0.7– 33.9) for mechanical reasons and 6.4%
(95% CI 0 – 13.4) and 9.2% (95% CI, 0.5 – 17.9) for infection, respectively ( gure 3). Mechanical reasons for failure were instability (n = 2 [4%]; one patient underwent
cup revision and was free of further complications; one patient underwent cup revision and the stem was later revised for loosening (n = 2 [4%]). Infection was the only non-mechanical failure mechanism (n = 4 [9%]). In all, 71 reoperations were performed in 25 patients (53%; range, one to eight), 59 of which (83%) were in the rst postoperative year. Predominant reasons for reoperations were infection (n = 46 [65%]), mechanical reasons (n = 15 [21%]), and local recurrences (n = 6 [8%]).
Mean MSTS scores at nal follow-up were available for 24 patients (51%). The mean score was 21 of 30 points (70%; range, 30% – 93%); these were evaluated after a median of 39 months (range, 6 – 68 months).
Figure 3. Competing risk analyses of implant failure. This plot shows the cumulative incidence of mechanical failure (type 1–3) and infection (type 4). Patient mortality was used as a competing event in these analyses.
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