98 Acta Orthopaedica 2011; 82 (1): 96–101 Table 2. Pre- and postoperative neurological func- tion in 31 patients with spine metastasis graded according to Frankel Preop. Follow-up A. Complete paraplegia B. No motor function C. Motor function useless D. Slight motor deficit E. No motor deficit 2 6 14 6 3 1 2 7 16 5 Survival (%) 100 80 60 40 20 0 0 n = 98 2 57 4 39 6 25 8 18 10 15 12 14 14 10 16 9 18 6 Months after surgery/number at risk Cumulative survival of lung cancer patients after surgery for skeletal metastases, with 95% confidence intervals. time of 2 (0–59) and females of 4 (0–127) months (Table 3). The cumulative 6-, 12-, and 18-month survival after surgery was 24% (CI: 15–33), 13% (CI: 6–20), and 6% (1–11) respec- tively (Figure). There was a difference between the median survival time after spinal surgery (2 (0–15) months) and after extremity sur- gery (4 (0–127) months) (p = 0.03) (Table 3). The univariate Cox regression analysis revealed an increased risk of death after surgery for patients with complete patholog- ical fracture, metastatic lesions in the vertebra, preoperative hemoglobin levels less than 10 g/dL, small cell cancer, and the absence of postoperative radiotherapy. The multivariate Cox analysis with the above 5 variables and age and sex showed that complete pathological fracture was a significant predictor of survival (Table 4). All the other factors studied—such as age, sex, smoking status, staging, time period of surgery, and chemotherapy—were not associated with an increased risk of death. Reoperations and complications The overall complication rate including reoperations was Table 3. Median survival of lung cancer patients with skeletal metastases. Time in months (range) All Males Females Histopathology Non-small cell cancer Adenocarcinoma Squamous cell carcinoma Low differentiated non-small cell cancer Large cell carcinoma Small cell cancer Other cancers Spinal surgery All Males Females Extremity surgery All Males Females Pathological fracture Complete Impending A 10 (0–168) 8 (1–60) 10 (0–168) 10 (0–168) 11 (1–168) 9 (0–43) 8 (1–12) 11 (6–60) 8 (1–23) 5 (1–24) 7 (2–29) 7 (2–29) 8 (3–20) 10 (0–168) 10 (1–60) 11 (0–168) 8 (0–80) 12 (2–168) A: time between diagnosis of lung cancer and death; B: time between surgical procedure and death. Table 4. Risk of death after surgery for skeletal metastases in lung cancer patients (Cox regression analysis) Factor Complete pathological fracture a Vertebral skeletal metastasis b Hemoglobin level < 10 g/dL c Small cell cancer d Postoperative radiotherapy (no) e HR 1.7 f 1.8 g 1.7 f 1.7 g 1.9 f 1.8 g 2.6 f 1.9 g 1.7 f 1.6 g 95% CI 1.1–2.6 1.0–3.0 1.0–2.7 0.9–3.4 1.1–3.4 0.9–3.7 1.2–6.0 0.8–4.8 1.1–2.6 0.9–2.9 Factor versus a impending pathological fracture, b femur, c ≥ 10 g/ dL,d adenocarcinoma, e yes; HR = hazard ratio, f unadjusted, g adjusted (HRs are adjusted for type of pathological fracture, location of skeletal metastasis, preoperative hemoglobin levels, type of lung cancer, postoperative radiotherapy, age, and sex). 20/98. 15 failed reconstructions in 14 patients led to a new operation. The reasons for these reoperations were poor initial fixation, local tumor progression, periprosthetic fracture, deep infection, paraplegia, material failure, nonunion, and technical error. The median time to failure was 1 (0–13) months (Table 5). Complications that were treated non-surgically were seen in 5 of the patients, including wound infection, gastric bleeding, poor initial fixation, and technical error (Table 6). B 3 (0–127) 2 (0–59) 4 (0–127) 4 (0–127) 4 (0–127) 2 (0–18) 2 (0–8) 7 (0–59) 2 (0–3) 1 (1–15) 2 (0–15) 2 (0–15) 1 (1–7) 4 (0–127) 3 (0–59) 4 (0–127) 2 (0–61) 4 (0–127) p-value 0.02 0.05 0.03 0.1 0.03 0.09 0.02 0.2 0.03 0.1