Different reconstructive techniques for tumours of the distal tibia

Abstract

Aims The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. Methods A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. Results Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. Conclusion Preservation of the epiphysis in patients with a distal tibial bone tumour is a safe and effective form of limb-sparing treatment. It requires rigorous preoperative planning after accurate analysis of the imaging. When joint-sparing resection is not indicated, ankle arthrodesis, either isolated tibiotalar or combined tibiotalar and subtalar arthrodesis, should be preferred over osteoarticular reconstruction. Cite this article: Bone Joint J 2020;102-B(11):1567–1573.

Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone

“…Although below-knee amputations for distal tibia tumors may provide excellent function with modern prostheses, limb salvage continues to be offered as a standard of care in view of psychological impact and quality of life [8,9]. A variety of procedures have been described in the literature to achieve limb salvage; however, each of them are associated with their inherent problems, namely [7], delay in weight-bearing and graft failures seen with autogenous bone grafting [12,13] as well as fibular autograft and arthrodesis [1,8,10,14]; infection and graft subsidence/lysis concerned with osteoarticular allografts [15][16][17]; distraction osteogenesis [2,14]; and also endoprosthetic reconstruction [3,[18][19][20] failing with infection or inadequate soft tissue coverage. e best option however remains debatable.…”

“…Restoration of the functional ankle joint has remained a challenge following distal tibia resections for bone tumors [5,7]. Biological reconstruction allows restoration of the bone in the defect but requires a fusion across the tibiotalar joint.…”

“…Biological reconstruction allows restoration of the bone in the defect but requires a fusion across the tibiotalar joint. Sambri et al [7] demonstrated ankle joint reconstruction using osteoarticular allografts but reported osteoarthritis following biological joint reconstruction in 3 of their 11 patients. However, the symptomatic and functional worsening was not associated with the degree of osteoarthritis and is a promising procedure if ankle stability can be established [7].…”

“…Sambri et al [7] demonstrated ankle joint reconstruction using osteoarticular allografts but reported osteoarthritis following biological joint reconstruction in 3 of their 11 patients. However, the symptomatic and functional worsening was not associated with the degree of osteoarthritis and is a promising procedure if ankle stability can be established [7]. Complex anatomy, deficient soft tissue, and forces of biomechanics at the ankle joint add significant stress to the construct [12,21,22].…”

“…Most resections include the articular surface, and reconstructions of these defects pose unique challenges including a complex bony anatomy and a thin soft tissue cover. Unlike around the knee or hip, there seems to be no reliable endoprosthetic or biological reconstruction for creating a functional joint at the ankle [1][2][3][4][5][6][7]. A below-knee amputation can give excellent functional outcomes and is therefore a suitable alternative to any reconstruction that fuses the tibiotalar joint [8,9].…”