Limb salvage surgery in bone tumour with modular endoprosthesis

Abstract

Thirty-three patients with bone tumours were treated by resection of the growth and reconstruction with a Kotz modular endoprosthesis. The average follow-up was for 50 months, ranging from 14 to 79 months. At the last review, 12 patients (36%) had died due to the tumour and 9 others (27%) had metastases. All 4 patients with proximal tibial reconstruction had poor functional results, due to an extension lag or to knee stiffness. Four of the six tumours of the proximal femur were complicated by local recurrence or dislocation of the hip, and had poor or fair functional results. Of the patients with distal femoral reconstruction, 17 out of 22 had excellent or good functional results. Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur.

Custom megaprosthetic replacement for proximal tibial tumours

“…The method described by Malawer and McHale [17] has been used by us, and we have achieved an excellent MSTS functional outcome in 49.6% and good in 27% of patients. The issue of extensor lag still remains one of the major causes for a decreased functional outcome after proximal tibial endoprosthetic replacement [23]. The mean extensor lag in our series was 18 (10-35)°.…”

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

“…Even in the most recent studies, the possibility of failure in the reconstruction of the extensor mechanism occurred in as much as 26% of patients [1,17,31], although one might believe this percentage would be reduced with rotation of the medial gastrocnemius and its suture to the patellar tendon [32]. However, this technique carries some risks, such as necrosis of the fasciocutaneous flap used [3].…”

Limb salvage for proximal tibial tumours using a modular prosthesis

“…Tumours of the distal femur can usually be removed with successful reconstruction [11,12], but with tumours of the proximal tibia complications are much more frequent.…”