Prosthetic arthroplasty of the knee after resection of a sarcoma in the proximal end of the tibia. A report of sixteen cases.

Horowitz, Stephen M.; Lane, Joseph M.; Otis, James C.; Healey, John H.

doi:10.2106/00004623-199173020-00017

Cited by 94 publications

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“…Passive range of motion was complete in extension and adequate for daily living activities in flexion in all of the patients evaluated (>100°). Extension lag was present only in one allograft patient whereas TKR patients had extension lag more frequently, as has been previously reported in the literature [9,15,13]. Time-distance parameters were altered without significant differences among groups.…”

Section: Discussionsupporting

confidence: 76%

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Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli

Donati

Benedetti

et al. 2007

International Orthopaedics (SICO

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Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results.Résumé Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l'étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l'étude de la boiterie incluant l'EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d'extension était notée. Tandis que le groupe TKR avait une réduction de l'activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l'appareil extenseur et perte d'extension. Bien qu'un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d'une cinématique anormale du genou. L'allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

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Section: Discussionsupporting

confidence: 76%

“…Several papers have addressed the clinical and functional advantages and drawbacks [5,7,12,23] of allograft reconstruction with respect to total knee replacement [9,11,13,15,16,18,24] in proximal tibia bone tumours, but only a few studies have documented the rate of functional recovery after surgery by means of gait analysis [10,24].…”

Section: Discussionmentioning

confidence: 99%

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli

Donati

Benedetti

et al. 2007

International Orthopaedics (SICO

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“…Not only has the tumour site seemed to affect the final outcome. Studies with more patients also show that an increase in the length of resected bone or extra-capsular resections leaving a larger soft tissue defect, both influenced the outcome negatively [1,10]. In our relatively small number of patients, the same effect could not be shown.…”

Section: Discussionmentioning

confidence: 59%

Functional outcome and life quality after endoprosthetic reconstruction following malignant tumours around the knee

Skaliczki

Antal

Kiss

et al. 2005

International Orthopaedics (SICOT)

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Between 1993 and 2002, we treated 43 patients with malignant musculoskeletal tumours of the knee region. All patients had partial resection of the femur or tibia together with endoprosthetic replacement. We were able to follow-up 23 patients with an average follow-up of 30 (12-97) months. Complications occurred in ten cases, of which one was a case of local recurrence. Most of the patients were completely satisfied with their condition, with a decreased walking distance as the only notable restriction. There was no correlation between the functional outcome and life quality assessment and the type of the implanted prosthesis, length of resected bone and type of resection. However, patients with tumours in the distal femur had significantly better functional and life quality outcome than those with a proximal tibial tumour.Résumé Entre 1993 et 2002 nous avons traité 43 malades avec une tumeur musculo-squelettique maligne de la région du genou. Tous les malades avaient une résection partielle du fémur ou du tibia avec remplacement prothétique. Nous avons suivi 23 malades avec un délai moyen de 30 (12-97) mois. Des complications se sont produites dans 10 cas dont une récidive locale. La plupart des malades ont été satisfaits du résultat avec un périmètre de marche diminué comme seule restriction notable. Il n'y avait aucune corrélation entre, d'une part les résultats fonctionnels et la qualité de vie et, d'autre part, le type de résection, la longueur de résection osseuse et le type de prothèse implantée. Cependant, les malades avec une tumeur du fémur distal avaient de meilleurs résultats pour la fonction et la qualité de vie que ceux atteints d'une tumeur du tibia proximal

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“…However, this was reduced to 12% with the use of a gastrocnemius flap to cover the wound. Horowitz [9] reported on 16 patients, also with a high infection rate.…”

Section: Resultsmentioning

confidence: 99%

Limb salvage for proximal tibial tumours using a modular prosthesis

Ilyas

Younge

Moreau

2000

International Orthopaedics

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We report early results after the resection of proximal tibial tumours followed by reconstruction using a modular prosthesis. The indication for wide resection was a malignant tumour in 13 patients, and a neglected giant cell tumour in 2. There were no mechanical failures during an average follow-up of 3.5 years. However, there were 5 peroneal nerve palsies, 1 complete sciatic nerve palsy, 1 vascular injury leading to an above knee amputation, and 2 deep prosthetic infections. There were 2 superficial skin necroses and 1 fracture proximal to the femoral prosthetic component. The mean post-operative Musculo-Skeletal Tumour Society (MSTS) score in 12 patients who still had their prosthesis in situ was 18.3 out of a possible total of 30 (range: 10-28). Limb salvage surgery in the proximal tibia has a high early complication rate even with the use of modern implants and improved techniques.

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Prosthetic arthroplasty of the knee after resection of a sarcoma in the proximal end of the tibia. A report of sixteen cases.

Cited by 94 publications

References 0 publications

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Functional outcome and life quality after endoprosthetic reconstruction following malignant tumours around the knee

Limb salvage for proximal tibial tumours using a modular prosthesis

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