Data from: Outcome after reconstruction of the proximal tibia – complications and competing risk analysis

Background and Objectives: The proximal tibia (pT) is a common site for bone tumors. Improvements in imaging, chemotherapy and surgical technique made limb salvage surgery the treatment of choice. Yet, reconstructions of the pT have been associated with less favorable outcome compared to other parts of the extremities. The aim of this study was to evaluate the outcome of patients with a modular endoprosthetic reconstruction of the pT. Methods: Eighty-one consecutive patients with an average age of 29 years underwent endoprosthetic reconstruction of the pT. Postoperative complications were categorized according to the ISOLS classification, and revision-free survival until first complication (any Type 1–5), soft tissue failure (Type 1), aseptic loosening (Type 2), structural failure (Type 3), infection (Type 4), and local tumor progression (Type 5) was estimated by using a Fine-Gray model for competing risk analyses for univariate and multivariable regression with Firth’s bias correction. Results: A total of 45 patients (56%) had at least one complication. Cumulative incidence for complication Types 1 to 5 at 5 years with death and amputation as competing events revealed a risk of 41% for the first complication, 14% for Type 1, 16% for Type 2, 11% for Type 3, 17% for Type 4, and 1% for Type 5. Conclusion: Despite inclusion of amputation and death as strong competing events, pT replacements are still associated with a high risk of postoperative failures. The results suggest that infection and soft tissue failures (Type 1 and 5) seem to depend from each other. Sufficient soft tissue reconstruction and closure allow better function and reduce the risk of infection as the most prominent complication. The use of a rotating hinge design has significantly reduced structural failures over time

PLOS One / Outcome after Reconstruction of the Proximal Tibia Complications and Competing Risk Analysis

Background and Objectives The proximal tibia (pT) is a common site for bone tumors. Improvements in imaging, chemotherapy and surgical technique made limb salvage surgery the treatment of choice. Yet, reconstructions of the pT have been associated with less favorable outcome compared to other parts of the extremities. The aim of this study was to evaluate the outcome of patients with a modular endoprosthetic reconstruction of the pT. Methods Eighty-one consecutive patients with an average age of 29 years underwent endoprosthetic reconstruction of the pT. Postoperative complications were categorized according to the ISOLS classification, and revision-free survival until first complication (any Type 15), soft tissue failure (Type 1), aseptic loosening (Type 2), structural failure (Type 3), infection (Type 4), and local tumor progression (Type 5) was estimated by using a Fine-Gray model for competing risk analyses for univariate and multivariable regression with Firths bias correction. Results A total of 45 patients (56%) had at least one complication. Cumulative incidence for complication Types 1 to 5 at 5 years with death and amputation as competing events revealed a risk of 41% for the first complication, 14% for Type 1, 16% for Type 2, 11% for Type 3, 17% for Type 4, and 1% for Type 5. Conclusion Despite inclusion of amputation and death as strong competing events, pT replacements are still associated with a high risk of postoperative failures. The results suggest that infection and soft tissue failures (Type 1 and 5) seem to depend from each other. Sufficient soft tissue reconstruction and closure allow better function and reduce the risk of infection as the most prominent complication. The use of a rotating hinge design has significantly reduced structural failures over time.(VLID)492415

Univariate and multivariable analyses of 1st and type 1 to 4 complications based on a Competing Risks analysis.^*

<p>HR—hazard ratio; CI—confidence interval of HR</p><p>* Type 5 complications excluded for too low number of events</p><p>Univariate and multivariable analyses of 1st and type 1 to 4 complications based on a Competing Risks analysis.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135736#t002fn002" target="_blank">*</a>}</p

Cumulative incidence of first complication (any Type 1 to 5) as assessed by CR analysis (see material and methods for details).

<p>Cumulative incidence of first complication (any Type 1 to 5) as assessed by CR analysis (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135736#sec006" target="_blank">material and methods</a> for details).</p

Cumulative incidence of complication types 1 to 5 over time as assessed by separate CR analysis for each type (see material and methods for details).

<p>Cumulative incidence of complication types 1 to 5 over time as assessed by separate CR analysis for each type (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135736#sec006" target="_blank">material and methods</a> for details).</p

Baseline characteristics and operative data.

<p>Baseline characteristics and operative data.</p