| Title |
What Factors Are Associated With Failure of Compressive Osseointegration Fixation?
|
|---|---|
| Published in |
Clinical Orthopaedics & Related Research, March 2017
|
| DOI | 10.1007/s11999-016-4764-9 |
| Pubmed ID | |
| Authors |
Ryland Kagan, Jacob Adams, Caroline Schulman, Rachel Laursen, Karina Espana, Jung Yoo, Yee-Cheen Doung, James Hayden |
| Abstract |
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. (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? 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. 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. 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 III, therapeutic study. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 2 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Science communicators (journalists, bloggers, editors) | 1 | 50% |
| Members of the public | 1 | 50% |
Mendeley readers
The data shown below were compiled from readership statistics for 73 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 73 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 8 | 11% |
| Student > Bachelor | 8 | 11% |
| Student > Doctoral Student | 8 | 11% |
| Student > Postgraduate | 5 | 7% |
| Researcher | 5 | 7% |
| Other | 11 | 15% |
| Unknown | 28 | 38% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 29 | 40% |
| Nursing and Health Professions | 5 | 7% |
| Engineering | 3 | 4% |
| Agricultural and Biological Sciences | 3 | 4% |
| Environmental Science | 1 | 1% |
| Other | 4 | 5% |
| Unknown | 28 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 March 2016.
All research outputs
#17,285,036
of 25,371,288 outputs
Outputs from Clinical Orthopaedics & Related Research
#5,586
of 7,298 outputs
Outputs of similar age
#210,066
of 324,421 outputs
Outputs of similar age from Clinical Orthopaedics & Related Research
#61
of 89 outputs
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