%0 Journal Article
%T Radiographic parameter-driven decision tree reliably predicts aseptic mechanical failure of compressive osseointegration fixation
%A Brooke Beckett
%A James B Hayden
%A Kagan
%A Kenneth R Gundle
%A Lindsay Parlee
%A Ryl
%A Yee-Cheen Doung
%J Acta Orthopaedica
%D 2020
%R https://doi.org/10.1080/17453674.2020.1716295
%X Background and purpose 〞 Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration. Patients and methods 〞 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test每retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test每retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model＊s predictions were compared with clinical outcomes and a confusion matrix was generated. Results 〞 6 of 8 reviewers had non-significant intra-rater ICCs forˋ≡ˋone parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52每100) and 87% (CI 74每94) respectively. The decision tree demonstrated 100% (CI 40每100) sensitivity and 89% (CI 75每96) specificity with the test cohort. Interpretation 〞 A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseointegration implants
%U https://www.tandfonline.com/doi/full/10.1080/17453674.2020.1716295