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Erschienen in: Clinical Orthopaedics and Related Research® 3/2017

29.02.2016 | Symposium: 2015 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage

What Factors Are Associated With Failure of Compressive Osseointegration Fixation?

verfasst von: Ryland Kagan, MD, Jacob Adams, MD, Caroline Schulman, BE, Rachel Laursen, BS, Karina Espana, BS, Jung Yoo, MD, Yee-Cheen Doung, MD, James Hayden, MD, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 3/2017

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Abstract

Background

Compressive osseointegration is as an alternative to traditional intramedullary fixation. Two- to 10-year survivorship and modes of failure have been reported; however, as a result of relatively small numbers, these studies are limited in their ability to identify risk factors for failure.

Questions/purposes

(1) What is survivorship free from aseptic mechanical and survivorship free from overall failure of compressive osseointegration fixation? (2) What patient factors (age, sex, body mass index [BMI], anatomic location of reconstruction, indication for reconstruction, radiation, chemotherapy) are associated with increased risk of failure?

Methods

Between 2006 and 2014, surgeons at one center treated 116 patients with 137 Compress® implants for lower extremity oncologic reconstructions, revision arthroplasty, and fracture nonunion or malunion. One hundred sixteen implants were available for review with a minimum of 2-year followup (mean, 4 years; range, 2–9 years). Kaplan-Meier survival plots were produced to examine survivorship and Cox regression modeling was used to generate hazard ratios (HRs) for potential risk factors for failure. Patient factors (age, sex, BMI, anatomic location of reconstruction, indication for reconstruction, radiation, chemotherapy) were obtained from chart review and an institutional database.

Results

Survivorship free from aseptic mechanical failure was 95% (95% confidence interval [CI], 91%–99%) at 18 months and 93% (95% CI, 86%–99%) at 4 years. Survivorship free from overall failure was 82% (95% CI, 75%–89%) at 18 months and 75% (95% CI, 66%–84%) at 4 years. Risk of overall failure was increased with reconstruction of the proximal tibia (HR, 4.42; 95% CI 0.98–19.9) and distal femur (HR, 1.74; 95% CI, 0.50–6.09) compared to the proximal femur (HR, 1; referent; p = 0.049). Risk of aseptic mechanical failure was increased with reconstruction of the proximal tibia (HR, 1; referent) and distal femur (HR, 0.37; 95% CI, 0.08–1.77) compared with the proximal femur (HR, 0, p = 0.048). Radiation was associated with increased risk of overall failure (HR, 3.85; 95% CI, 1.84–8.02; p < 0.003), but not aseptic mechanical failure. Age, sex, BMI, chemotherapy, and surgical indication were not associated with increased risk of aseptic or overall failure.

Conclusions

This study questions the use of age as a contraindication for the use of this technology and suggests this technology may be considered in proximal femoral reconstruction and for patients with indications other than primary oncologic reconstructions. Future research should establish long-term survivorship data to compare this approach with conventional intramedullary stems and to evaluate the potential benefits of preventing stress shielding and preserving bone stock in revision situations.

Level of Evidence

Level III, therapeutic study.
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Metadaten
Titel
What Factors Are Associated With Failure of Compressive Osseointegration Fixation?
verfasst von
Ryland Kagan, MD
Jacob Adams, MD
Caroline Schulman, BE
Rachel Laursen, BS
Karina Espana, BS
Jung Yoo, MD
Yee-Cheen Doung, MD
James Hayden, MD, PhD
Publikationsdatum
29.02.2016
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 3/2017
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-016-4764-9

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