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International Orthopaedics

, Volume 42, Issue 10, pp 2475–2481 | Cite as

Tumour endoprosthesis replacement in the proximal tibia after intra-articular knee resection in patients with sarcoma and recurrent giant cell tumour

  • Jendrik Hardes
  • Marcel-Philipp Henrichs
  • Georg Gosheger
  • Wiebke Guder
  • Markus Nottrott
  • Dimosthenis Andreou
  • Eike Bormann
  • Maria Eveslage
  • Gregor Hauschild
  • Arne Streitbürger
Original Paper
  • 183 Downloads

Abstract

Purpose

Proximal tibia replacements are commonly associated with post-operative complications and poor functional results due to an insufficiency of the extensor mechanism.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Proximal tibia replacement Reattachment tube Extensor mechanism Sarcoma Tumour prosthesis Megaprosthesis 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Mavrogenis AF, Pala E, Angelini A, Ferraro A, Ruggieri P (2013) Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol 107:335–342.  https://doi.org/10.1002/jso.23216 CrossRefPubMedGoogle Scholar
  2. 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
  3. 3.
    Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br 81:488–494CrossRefGoogle Scholar
  4. 4.
    Hardes J, Henrichs MP, Hauschild G, Nottrott M, Guder W, Streitbuerger A (2017) Silver-coated megaprosthesis of the proximal tibia in patients with sarcoma. J Arthroplast 32:2208–2213.  https://doi.org/10.1016/j.arth.2017.02.054 CrossRefGoogle Scholar
  5. 5.
    Jentzsch T, Erschbamer M, Seeli F, Fuchs B (2013) Extensor function after medial gastrocnemius flap reconstruction of the proximal tibia. Clin Orthop 471:2333–2339.  https://doi.org/10.1007/s11999-013-2851-8 CrossRefPubMedGoogle Scholar
  6. 6.
    Gosheger G, Hillmann A, Lindner N, Rödl R, Hoffmann C, Bürger H, Winkelmann W (2001) Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop 393:264–271CrossRefGoogle Scholar
  7. 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
  8. 8.
    Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop 450:164–171CrossRefGoogle Scholar
  9. 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. 10.
    Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 153:106–120Google Scholar
  11. 11.
    Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242CrossRefGoogle Scholar
  12. 12.
    Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection (2014) Definition of periprosthetic joint infection. J Arthroplast 29:1331.  https://doi.org/10.1016/j.arth.2014.03.009 CrossRefGoogle Scholar
  13. 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
  14. 14.
    Bickels J, Wittig JC, Kollender Y, Neff RS, Kellar-Graney K, Meller I, Malawer MM (2001) Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. J Arthroplast 16:856–862CrossRefGoogle Scholar
  15. 15.
    Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI (2006) Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop 453:328–334CrossRefGoogle Scholar
  16. 16.
    Hardes J, Ahrens H, Nottrott M, Dieckmann R, Gosheger G, Henrichs M-P, Streitbürger A (2012) Attachment tube for soft tissue reconstruction after implantation of a mega-endoprosthesis. Oper Orthop Traumatol 24:227–234.  https://doi.org/10.1007/s00064-011-0080-4 CrossRefPubMedGoogle Scholar
  17. 17.
    Myers GJC, Abudu AT, Carter SR, Tillman RM, Grimer RJ (2007) The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours. J Bone Joint Surg Br 89:1632–1637CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Jendrik Hardes
    • 1
    • 2
  • Marcel-Philipp Henrichs
    • 1
  • Georg Gosheger
    • 1
  • Wiebke Guder
    • 1
  • Markus Nottrott
    • 1
  • Dimosthenis Andreou
    • 1
  • Eike Bormann
    • 3
  • Maria Eveslage
    • 3
  • Gregor Hauschild
    • 1
  • Arne Streitbürger
    • 1
  1. 1.Department of Orthopaedics and Tumor OrthopaedicsUniversity Clinics of MünsterMünsterGermany
  2. 2.Department of Orthopaedics and Tumour OrthopaedicsMünster University HospitalMünsterGermany
  3. 3.Institute of Biostatistics and Clinical ResearchUniversity of MünsterMünsterGermany

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