Allograft-Prosthetic Composite Reconstruction of the Proximal Part of the Tibia

Abstract

After osteoarticular resection of destructive tumors of the proximal part of the tibia, an allograft-prosthetic composite reconstruction can provide consistently good functional results with an acceptably low complication rate. Technical aspects of the procedure that may favorably affect outcome include soft-tissue coverage with muscle flaps and rigid fixation with a long-stemmed implant.

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

“…With the number of patients we had in this study, no difference between cemented and cementless prostheses was detectable for overall survival and specifically for Type 2 failures (aseptic loosening) or Type 4 failures (infection). The implant we have used can be assembled as a full metallic implant or as an APC with the functional advantages offered by biologic reattachment of tendons on the graft [2,7,8,15,38]. In the presented series, APCs were used also after extraarticular resections of the knee using a proximal tibial allograft with its entire extensor apparatus in 12 cases.…”

“…Biologic tendinous reattachment to the metallic prosthesis is not possible and usually results in loss of strength of hip abductors and the extensor mechanism of the knee. For this reason, allograft-prosthesis composites have been introduced with the aim of combining the advantages of endoprostheses with the functional improvement resulting from biologic tendinous reattachment of the hip abductors and patellar tendon [2,7,8,15,38].…”

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

“…In a study by Ayerza et al [3], 24 of 34 (71%) patients with osteoarticular allografts achieved full extension without an extensor lag, whereas the remaining 10 (29%) patients had an average extensor lag of 6.5°. Gilbert et al [19] evaluated 12 patients with allograft-prosthetic composite reconstructions, and did not find an extensor lag in nine of 12 (75%) patients, while the remaining three (25%) patients had an extensor lag between 5°and 15°. Biau et al [4] studied 26 patients with allograft-prosthetic components and found a mean extensor lag of 7.7°.…”

“…This clearly is inferior compared with extension after allograft reconstruction, where full extension may be more reliably achieved [3, 4, 11-13, 16, 19, 30, 41]. Based on the few reports [3,4,19] evaluating the extensor function specifically, patellar tendon reconstruction with allogenic tissue from a proximal tibia allograft sutured to the recipient's remnant patellar tendon restores active knee extension most reliably and provides a stable knee. In a study by Ayerza et al [3], 24 of 34 (71%) patients with osteoarticular allografts achieved full extension without an extensor lag, whereas the remaining 10 (29%) patients had an average extensor lag of 6.5°.…”

CT Lesion Model-Based Structural Allografts: Custom Fabrication and Clinical Experience

“…Brune/Hesselbarth/Seifert/Nowack/ von Versen/Smith/Seifert creased resection or component shift, cement or cement and screw reconstruction, metal prosthetic augmentation or impaction grafting [11][12][13]. For revision TKA, it has been shown, that early results of structural allografts are similar to those of standard metal augmentation [14].Further studies have been performed to test allograftprosthesis composites in the reconstruction of the humerus after tumour resection, for the reconstruction of the proximal tibia [15,16] and for total elbow arthroplasty [17][18][19]. Among the advantages in using structural allografts are the availability of capsular soft tissue attachments with which to reconstruct the salvaged host soft tissues (as demonstrated in the second case study, see below).…”