Custom megaprosthetic replacement for proximal tibial tumours

Abstract

We analysed 133 patients treated with resection and endoprosthetic proximal tibial replacement from 1988 to 2000. Mean age was 22.3 years and osteosarcoma was the most common tumour. Average follow-up was 59.4 months. An excellent functional result was achieved in 63 patients and a good result in 36. The number of patients who had no evidence of disease was 102. Twenty-four patients died due to disease. Infection was the most common complication, followed by periprosthetic fracture and aseptic loosening. The 5-year limb survival rate was 85.5%.Résumé Nous avons analysé 133 malades, traités par ré-section et remplacement endoprothétique du tibia proximal de 1988 à 2000. L'âge moyen était 22.3 ans et l'ostéosarcome était la tumeur la plus fréquente. Le délai moyen de suivi était 59.4 mois. Un excellent résultat fonctionnel a été obtenu pour 63 malades et un bon ré-sultat pour 36. Le nombre de malades qui n'avaient pas de signe de maladie était 102. Vingt-quatre malades sont morts à cause de la maladie. L'infection était la complication la plus fréquente, suivi par les fractures péripro-thétiques et le descellement aseptique. La présence du membre à 5 ans était de 85.5%.

Allograft-Prosthetic Composite in the Proximal Tibia After Bone Tumor Resection

“…This confirms the well-known problem of colonization of the prosthetic components, particularly in the polyethylene parts, by methicillin-resistant Staphylococcus epidermidis [27]. Also, patients receiving postoperative chemotherapy and those undergoing revision surgery resulting from previous complications are at higher risk for infection [2,12,19,28].…”

Distal femoral tumours treated by resection and custom mega-prosthetic replacement

“…We observed, from this and earlier studies, that patients with distal femoral endoprosthetic replacement have a better limb survival although patient survival of proximal tibial replacements is superior [15]. This observation has also been made by other authors [11][12][13].…”

“…By following the sleeve resection technique of quadriceps musculature, we were able to achieve an excellent or good functional outcome in 82.5% of patients, which is comparable to the 84% reported by Mittermayer et al [16]. The reconstructive procedure after resection of distal femoral tumours has to be based on several considerations, such as durability of the surgical procedure, the oncological prognosis, restoration of anatomy and function and the needs of the patient [15]. The surgical procedure chosen should be fully evaluated and compared with other alternatives while addressing the possible complications.…”

“…Local recurrence occurred in 16 patients, of whom nine underwent amputation and seven underwent revision surgery. Thirteen patients who developed local recurrence died, proving that local recurrence is a poor prognostic factor [15].…”

“…This places tremendous responsibility on tumour surgeons to provide durable and fully functional solutions for the patient. Progress in biomedical engineering along with better surgical and chemotherapeutic techniques has increased overall 5-year survival rate after endoprosthetic replacement from 20% to 85% in the past three decades [1,4,8,12,15].…”