Prosthetic reconstruction for tumours of the distal tibia and fibula

Abstract

Primary malignant bone tumours of the distal tibia or the distal fibula are very rare. Amputation has been a standard surgical treatment with satisfactory functional results obtained using an appropriate prosthesis. As the surgery of limb salvage has developed, reconstruction has been attempted using autograft, allograft, implanted prostheses and composites.

Treatment of primary malignant bone tumours of the distal tibia

“…Such procedures offer a functional and cosmetic limb, but long-term survival is questioned and the procedure is not recommended for children. Furthermore endoprostheses of the distal tibia are associated with many problems, such as talar collapse, limited function and stem loosening [1,11,12]. The inclusion of a trans-talar and trans-calcaneal stem improves primary rotational stability.…”

“…However, as with all prostheses, there is a risk of loosening and problems with talar collapse. So far, long-term results are not convincing [1,11].…”

“…The less malignant behaviour and advances in oncological treatment tempt one to use limb salvage reconstruction methods such as allograft and/or microvascular fibula transfer, bone transport, prosthesis or composites [3,5,6,11]. However, limb salvage surgery of the distal tibia presents several difficulties, including soft tissue coverage and ankle joint biomechanics.…”

“…A tumour prosthesis replacing the ankle joint is commercially available, but there are few reports detailing endoprosthetic replace-ment. Prosthetics allow quick functional recovery and maintains ankle joint movement [1,8,11]. However, as with all prostheses, there is a risk of loosening and problems with talar collapse.…”

Total tibial endoprosthesis including ankle joint and knee joint replacement in a patient with Ewing sarcoma

“…Limb salvage surgery with endoprosthetic replacement of the distal tibia and the ankle joint has been described, with good functional outcome (Abudu et al 1999, Lee et al 1999, Natarajan et al 2000. Nevertheless, Abudu et al (1999) and Lee For the first time, we have described a total endoprosthetic replacement of the complete tibia including a rotating-hinge knee prosthesis and a trans-talar and trans-calcanear stem.…”