Limb salvage in distal tibial osteosarcoma using a custom mega prosthesis

Abstract

We have assessed the oncological and functional results of limb salvage surgery using a custom-made endoprosthetic replacement in six patients (mean age 17 years) with distal tibial osteosarcoma (stage IIB). A wide margin excision was possible in three, marginal in two and contaminated in one. Skeletal reconstruction was performed using a locally designed and manufactured custom-made distal tibial and ankle replacement prosthesis. Two patients developed local recurrence and one necrosis of the flap and deep infection. In three in whom the prosthesis remained in place the mean functional score according to the rating system of the Musculoskeletal Tumour Society was 24.3/30. In carefully selected patients limb salvage with prosthetic replacement is possible for distal tibial osteosarcomas.

Treatment of primary malignant bone tumours of the distal tibia

“…Such procedures offer a functional and cosmetic limb, but long-term survival is questioned and the procedure is not recommended for children. Furthermore endoprostheses of the distal tibia are associated with many problems, such as talar collapse, limited function and stem loosening [1,11,12]. The inclusion of a trans-talar and trans-calcaneal stem improves primary rotational stability.…”

Reimplantation of the resected tumour-bearing segment after recycling using liquid nitrogen for osteosarcoma

“…The advances in radiological imaging and the increased effective use of adjuvant treatment, both chemotherapy and irradiation, share the credit for increasing successful limb salvage surgery [26]. Currently, limb salvage is the standard procedure for treatment of malignant bone tumours in many centres [8,9,20,23,24].…”

Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index

“…Reconstructive procedures as part of a multidisciplinary treatment concept have abolished primary amputation without compromising survival and local recurrence-free survival [12,18]. Beyond survival, there is little information on physical impairment and disability [13][14][15]20], but evaluation of the functional outcome is becoming increasingly important in the increasing proportion of long-term survivors.…”