Tumour endoprosthesis replacement in the proximal tibia after intra-articular knee resection in patients with sarcoma and recurrent giant cell tumour
- 64 Downloads
Proximal tibia replacements are commonly associated with post-operative complications and poor functional results due to an insufficiency of the extensor mechanism.
This study evaluated the clinical results with a special emphasis of the extensor mechanism reconstruction with a reattachment tube and complications after intra-articular resection of the proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS®) in 98 patients (median age 18 years) with malignant bone tumours or giant cell tumours.
Kaplan–Meier analysis showed that the limb survival rates were 94.9, 90.5 and 74.5% at one, two and ten years, respectively. Periprosthetic infection was the most common reason for secondary amputation (eight patients). The cumulative incidence rates of prosthetic failure (Henderson II–IV) were 18% at two years and 29% at five years post-operatively. An active extension deficit of more than 10° was noted in six patients only.
These results suggest that limb salvage with tumour prostheses after intra-articular resection can achieve good functional results with an active extension of the knee in the majority of patients. While mechanical complications can be treated successfully with revision surgery, periprosthetic infection continues to be the main reason for secondary amputation.
KeywordsProximal tibia replacement Reattachment tube Extensor mechanism Sarcoma Tumour prosthesis Megaprosthesis
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 2.Puchner SE, Kutscha-Lissberg P, Kaider A, Panotopoulos J, Puchner R, Böhler C, Hobusch G, Windhager R, Funovics PT (2015) Outcome after reconstruction of the proximal tibia—complications and competing risk analysis. PLoS One 10:e0135736. https://doi.org/10.1371/journal.pone.0135736 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Bus MPA, van de Sande MAJ, Fiocco M, Schaap GR, Bramer JAM, Dijkstra PDS (2017) What are the long-term results of MUTARS(®) modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal tibia? Clin Orthop 475:708–718. https://doi.org/10.1007/s11999-015-4644-8 CrossRefPubMedGoogle Scholar
- 9.Henderson ER, O’Connor MI, Ruggieri P, Windhager R, Funovics PT, Gibbons CL, Guo W, Hornicek FJ, Temple HT, Letson GD (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Joint J 96–B:1436–1440. https://doi.org/10.1302/0301-620X.96B11.34747 CrossRefPubMedGoogle Scholar
- 10.Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 153:106–120Google Scholar
- 13.Bus MPA, van de Sande MAJ, Taminiau AHM, Dijkstra PDS (2017) Is there still a role for osteoarticular allograft reconstruction in musculoskeletal tumour surgery? A long-term follow-up study of 38 patients and systematic review of the literature. Bone Joint J 99–B:522–530. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0443.R2 CrossRefPubMedGoogle Scholar