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. 2021 May 21;13(11):2510.
doi: 10.3390/cancers13112510.

Does the Duration of Primary and First Revision Surgery Influence the Probability of First and Subsequent Implant Failures after Extremity Sarcoma Resection and Megaprosthetic Reconstruction?

Christoph Theil  1 , Kristian Nikolaus Schneider  1 , Georg Gosheger  1 , Ralf Dieckmann  1   2 , Niklas Deventer  1 , Jendrik Hardes  1   3 , Tom Schmidt-Braekling  1 , Dimosthenis Andreou  1   4
Affiliations

Does the Duration of Primary and First Revision Surgery Influence the Probability of First and Subsequent Implant Failures after Extremity Sarcoma Resection and Megaprosthetic Reconstruction?

Christoph Theil et al. Cancers (Basel). .

Abstract

Complications in megaprosthetic reconstruction following sarcoma resection are quite common. While several risk factors for failure have been explored, there is a scarcity of studies investigating the effect of the duration of surgery. We performed a retrospective study of 568 sarcoma patients that underwent megaprosthetic reconstruction between 1993 and 2015. Differences in the length of surgery and implant survival were assessed with the Kaplan-Meier method, the log-rank test and multivariate Cox regressions using an optimal cut-off value determined by receiver operating curves analysis using Youden's index. 230 patients developed a first and 112 patients a subsequent prosthetic failure. The median duration of initial surgery was 210 min. Patients who developed a first failure had a longer duration of the initial surgery (225 vs. 205 min, p = 0.0001). There were no differences in the probability of infection between patients with longer and shorter duration of initial surgery (12% vs. 13% at 5 years, p = 0.492); however, the probability of mechanical failure was higher in patients with longer initial surgery (38% vs. 23% at 5 years, p = 0.006). The median length of revision surgery for the first megaprosthetic failure was 101 min. Patients who underwent first revision for infection and did not develop a second failure had a longer median duration of the first revision surgery (150 min vs. 120 min, p = 0.016). A shorter length of the initial surgery appears beneficial, however, the notion that longer operating time increases the risk of deep infection could not be reproduced in our study. In revision surgery for infection, a longer operating time, possibly indicating a more thorough debridement, appears to be associated with a lower risk for subsequent revision.

Keywords: megaprosthesis; periprosthetic joint infection; revision surgery; sarcoma; tumor endoprosthesis.

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Conflict of interest statement

C.T., D.A., T.S.-B., R.D., N.D. have received travel expenses or did paid lectures during the study period but outside the submitted work from Implantcast GmbH, Buxtehude, Germany. G.G. reports a patent for silver coating of metallic endoprostheses with royalties paid by Implantcast GmbH, Buxtehude, Germany outside the submitted work. J.H. reports a research grant paid by Implantcast GmbH, Buxtehude, Germany outside the submitted work. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
STROBE diagram showing inclusion of patients.
See this image and copyright information in PMC

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