Endoprosthetic replacement of the proximal tibia

Abstract

We 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.

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

“…Biau et al [4] studied 26 patients with allograft-prosthetic components and found a mean extensor lag of 7.7°. However, comparing our results with those from other series [5,22,38] using medial gastrocnemius flap reconstructions, we observed a slightly better outcome in our patients. Bickels et al [5], for example, reviewed 55 patients during a 20-year period and found full extension to an extension lag of 20°in 44 (78%) patients, an extensor lag of 20°to 30°in 10 (19%) patients, and one greater than 40°in one (3%) patient.…”

“…Unfortunately, full extension was not defined by a lag of 0°, which does not allow further comparison with other reports. The mean extensor lag of 50 patients studied by Grimer et al [22] was 30°. When using a medial gastrocnemius flap, there is debate regarding whether to augment the attachment with some kind of synthetic material [3,5,7,9,14,20,24,31,[37][38][39][40][41].…”

“…Because tumors of the proximal tibia are relatively rare, our study group was relatively small [13,22,32]. Thus, we were unable to include a control group in which another surgical technique could have been used [12,40,41].…”

“…The proximal tibia is a rarely affected site of primary malignant bone tumors [13,22,32]. At this location, the patellar tendon often has to be resected together with the tumor [5,24,37].…”

Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach

“…Kendall et al [16] reported functional deficits were mainly the result of a compromised extensor mechanism. Avulsion of the patellar ligament is one mechanism of compromising the extensor mechanism, with a reported incidence of 10.5% to 100% [1,13]. In the absence of patellar ligament avulsion, attenuation may occur without complete avulsion.…”