Cemented endoprosthetic reconstruction of the proximal tibia: how long do they last?
BACKGROUND
The few available studies documenting the long-term survival of cemented proximal tibial endoprostheses for musculoskeletal tumors do not differentiate between stem designs or patient diagnosis. There is wide variation in survival rates reported, possibly a result of this heterogeneity in patient population and implant design.


OBJECTIVE
We therefore asked: (1) How long do proximal tibial endoprostheses last? (2) What is the typical long-term functional result after proximal tibial replacement? And (3) what are the short- and long-term complications associated with endoprosthetic reconstruction of the proximal tibia, particularly with respect to the soft tissue reconstruction?


METHODS
We retrospectively reviewed 52 patients with 52 proximal tibial endoprosthetic reconstructions for a tumor-related diagnosis. Kaplan-Meier survivorship analysis was performed using revision of the stemmed components for any reason as an endpoint for implants, and death due to disease progression for patients. Function was assessed using the MSTS scoring system. The minimum followup was 1 month (mean, 96 months: range, 1-284 months; median, 69 months).


RESULTS
Using revision of the stemmed components for any reason as an end point, overall prosthesis survival at 5, 10, 15, and 20 years was 94%, 86%, 66%, and 37%, respectively. The 29 modular implants demonstrated a trend toward improved survival compared to the 23 custom-designed components, with a 15-year survivorship of 88% versus 63%. The mean postoperative Musculoskeletal Tumor Society score at most recent followup was 82% of normal function (mean raw score, 24.6; range, 4-29).


CONCLUSIONS
Cemented endoprosthetic reconstruction of the proximal tibia provides a reliable method of reconstruction following tumor resection.
Schwartz
Adam J
AJ
Department of Orthopaedic Surgery, University of California Los Angeles Medical Center, Santa Monica, CA, USA. schwartz.adam@mayo.edu
Kabo
J Michael
JM
Eilber
Fritz C
FC
Eilber
Frederick R
FR
Eckardt
Jeffrey J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D001843:Bone Cements