Endoprosthetic replacement of the proximal tibia

Abstract

W e have performed endoprosthetic replacement after resection of tumours of the proximal tibia on 151 patients over a period of 20 years. During this period limb-salvage surgery was achieved in 88% of patients with tumours of the proximal tibia. Both the implant and the operative technique have been gradually modified in order to reduce complications. An initial rate of infection of 36% has been reduced to 12% by the use of a flap of the medial gastrocnemius, to which the divided patellar tendon is attached. Loosening and breakage of the implant have been further causes of failure. We found that the probability of further surgical procedures being required was 70% at ten years and the risk of amputation, 25%. The development of a new rotating hinge endoprosthesis may lower the incidence of mechanical problems.Limb salvage for tumours of the proximal tibia is fraught with complications, but the good functional outcome in successful cases justifies its continued use. J Bone Joint Surg [Br] 1999;81-B:488-94. Received 24 June 1998; Accepted after revision 13 October 1998 The proximal tibia is the second most common site for primary bone tumours. Some 12% to 15% of osteosarcomas, 11% of Ewing's sarcomas and 6% of chondrosarcomas will be located here.

Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

“…Benefits and complications have been described for the different reconstruction procedures [1,4,6,[8][9][10].…”

“…Endoprosthetic reconstruction of the proximal tibia has the advantages of full weightbearing in the first weeks postoperatively, giving the patient relatively rapid functional restoration [6,[8][9][10]. On the other hand, the use of biological reconstruction gives the chance to restore the bone stock and reconstruct the extensor mechanism [1,2,4].…”

Proximaler Tibiaersatz und alloplastische Rekonstruktion des Streckapparats nach Resektion kniegelenksnaher Tumoren

“…Eine Wiederherstellung der Gelenkfunktion gelingt häufig nur durch die Verwendung von Spezialprothesen mit hohem Kopplungsgrad. Das Ausmaß der tibialen Resektion [5], das verwendete Prothesendesign [6,7] und die Notwendigkeit der Resektion des Tibiofibulargelenks [8] sind Faktoren, die das Implantatsurvival und das klinische Outcome wesentlich beeinflussen. Durch die unmittelbar subkutane Lage der Tibiavorderkante war früher jede Form der endoprothetischen Rekonstruktion problematisch, da schon kleinste Hautnekrosen den Therapieerfolg durch Protheseninfektionen gefährden konnten.…”

Proximaler Tibiaersatz mit Transfer des M. Gastrocnemius

“…Mit nur einem Lokalrezidiv (7,8%) ist unser Ergebnis vergleichbar mit anderen Arbeiten. Die dort erzielten Werte bewegen sich zwischen 4% und 10% [2,8].…”

“…2-jähri-gen Nachuntersuchungszeitraum [ [8,9] oder zwischen 100 mm und 257 mm bei 16 Patienten [10].…”