Titanium Implant Failure After Chest Wall Osteosynthesis.
BACKGROUND
Our objective was to assess potential contributing factors to implant failure (displacement or rupture) after titanium chest wall osteosynthesis.


METHODS
We retrospectively reviewed the clinical data and preoperative and postoperative computed tomographic scans of patients undergoing chest wall osteosynthesis with titanium implants: the Stratos or the Matrix Fixation System in two European departments of thoracic surgery. The indications for titanium chest wall osteosynthesis, the type and number of implants, the topography of the reconstruction, surgical site infection, and role of associated flap and mesh were assessed.


RESULTS
Between January 2009 and January 2013, 54 patients underwent osteosynthesis after surgical correction of chest wall deformities (n = 25, 46.2%) or to bridge the defect after tumor removal (n = 29, 53.7%). The topography of osteosynthesis was anterior (n = 20), lateral (n = 3), or posterior (n = 1), an average of 1.9 ± 0.9 implants (range, 1 to 5 implants) being used. A combined mesh restored continuity of the chest wall in 15 patients, and muscle flap coverage was performed in 20. The mean follow-up time was 20.2 ± 8.4 months (range, 3 to 48 months). Among these 54 patients, 24 (44%) experienced an implant failure. Seven (29%) were symptomatic. Broken (n = 20, 83.3%) or displaced (n = 4, 16.7%) implants were removed with or without replacement. In patients with broken or displaced implants, the mean duration without implant failure was 6.6 ± 3.1 months (range, 1 to 12 months). There was a significant relationship between the anterior topography of osteosynthesis and implant failure (p = 0.02).


CONCLUSIONS
Long-term follow-up after chest wall osteosynthesis using titanium implants is required, especially in anteriorly placed implants. The high rate of implant failure at 1 year advocates for early removal whenever possible and suggests the need for improvements in design.
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France; U1046, INSERM, Montpellier University, Montpellier, France. Electronic address: jeanphilippe.berthet@gmail.com.
Jean-Philippe
JP
Berthet
General Thoracic Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Abel
A
Gomez Caro
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Laurence
L
Solovei
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Matthieu
M
Gilbert
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Sébastien
S
Bommart
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Philippe
P
Gaudard
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Ludovic
L
Canaud
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Pierre
P
Alric
Thoracic Surgery Department, University Hospital Arnaud de Villeneuve, Montpellier, France.
Charles-Henri
CH
Marty-Ané
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013896:Thoracic Diseases / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods*; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
D014025:Titanium