Limb salvage for proximal tibial tumours using a modular prosthesis

Abstract

We report early results after the resection of proximal tibial tumours followed by reconstruction using a modular prosthesis. The indication for wide resection was a malignant tumour in 13 patients, and a neglected giant cell tumour in 2. There were no mechanical failures during an average follow-up of 3.5 years. However, there were 5 peroneal nerve palsies, 1 complete sciatic nerve palsy, 1 vascular injury leading to an above knee amputation, and 2 deep prosthetic infections. There were 2 superficial skin necroses and 1 fracture proximal to the femoral prosthetic component. The mean post-operative Musculo-Skeletal Tumour Society (MSTS) score in 12 patients who still had their prosthesis in situ was 18.3 out of a possible total of 30 (range: 10-28). Limb salvage surgery in the proximal tibia has a high early complication rate even with the use of modern implants and improved techniques.

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

“…Nevertheless, it has the advantage of allowing direct suture from host to allograft, minimising bone resection and preserving the articular surface of the distal femur and patella. Better final functional results were found compared with other methods [5,7,14].…”

“…These limitations may be attributed to difficulties in the reconstruction of the extensor mechanism [3,5,15]. A procedure used to overcome this problem is the medial gastrocnemius transposition to the residual patellar tendon [3,8,14]. In the osteochondral allograft surgical procedure, a higher incidence of infection, fractures, and loss of fixation is reported [5,12,17,20,23].…”

Custom megaprosthetic replacement for proximal tibial tumours

“…Gait and stride length are, however, not significantly different between endoprosthetic replacement and above-knee amputation using an external prosthesis [26]. Endoprosthetic replacement is also associated with several possible complications like failure of primary wound healing, flap necrosis, secondary infection, aseptic loosening, fracture and breakage [1,13,15,24,25].…”

Modular megaprosthesis for distal femoral tumors

“…With the development of modern chemotherapy the prognosis for malignant tumors has improved greatly and encouraged surgeons to consider limb salvage surgery in most cases [1]. The site of tumor is an important factor, however, as many studies have shown poor results in the treatment of proximal tibial tumors compared to distal femoral tumors [7,10,13]. The trend, therefore, may be shifting towards the use of prosthesis in limb salvage, particularly for distal femoral tumors.…”

“…Our preferred option following resection of the tumor is the use of a modular prosthesis, i.e., standard-sized components with varying lengths according to the amount of bone resected. This procedure has produced consistently better results for distal femoral tumors than for proximal tibial tumors for several reasons [7,10,13]. The prosthesis can be used either with or without cement [3,9,11], and results have been almost the same in both cases at midterm follow-up.…”