Extendible replacements of the proximal tibia for bone tumours.
Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease and, of the remaining 15, four had above-knee amputations for complications. Infection occurred in seven patients; in five it was related to the lengthening procedure. Aseptic loosening is inevitable in the younger children and only two have avoided a revision, amputation or other major complication; both were aged 12 years at the time of the initial surgery. Despite this, 11 children are alive with a functioning leg and a mean Musculoskeletal Tumour Society functional score of 83%. The lengthening mechanisms used in our series required extensive open operations. We are now using a simpler, minimally invasive, technique which we hope will decrease the incidence of complications. At present, the use of extendible prostheses of the proximal tibia remains an experimental procedure.
Grimer
R J
RJ
Royal Orthopaedic Hospital Oncology Service, Birmingham, England.
Belthur
M
M
Carter
S R
SR
Tillman
R M
RM
Cool
P
P
D000293:Adolescent; D000671:Amputation, Surgical; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002804:Chondroblastoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018219:Histiocytoma, Benign Fibrous / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*