title: Knee joint reconstruction after hemiarticular resection using pedicled patella and vascularized fibular graft.
abstract: Between 1999 and 2005, seven patients had resection of tumors around the knee joint that involved half of the articular surface of the femoral or tibial side. Average age of the patients was 28 years (range, 14-40). Tumor pathology was giant cell tumor in four patients, osteoblastoma in two, and benign fibrous histocytoma in one patient. Two patients had recurrent tumors. The tumor was located in the distal femur in five patients and in the proximal tibia in the remaining two. The ipsilateral patella pedicled on the infrapatellar fat pad was used to substitute the resected articular surface and a vascularized fibula osteoseptocutaneous flap was used to reconstruct the metaphyseal defect. Average follow-up period was 6.5 years (range, 3.5-10 years). All flaps survived. Average time to bone union was 3.5 months (range, 3-4 months), and average time to full weight-bearing was 5 months (range, 4-6 months). No radiological signs of avascular necrosis of the patella were observed in any patient. Two patients required secondary procedures for correction of instability. One patient had local recurrence. At final follow-up, the median range of knee motion was from 10° to 100°. The average Knee Society Score (KSS) was 76 points (range; 50-85 points), and the average KSS functional score was 76.6 points (range, 70-90 points). In conclusion, the procedure is a reliable option for after resection of tumors that involve half the articular surface of the femur or the tibia.
authors.affiliation: Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt. tarek_elgammal@yahoo.co
authors.forename: Tarek A
authors.initials: TA
authors.lastname: El-Gammal
authors.forename: Amr
authors.initials: A
authors.lastname: El-Sayed
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Kotb
authors.forename: Waleed Riad
authors.initials: WR
authors.lastname: Saleh
authors.forename: Yasser Farouk
authors.initials: YF
authors.lastname: Ragheb
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D018219:Histiocytoma, Benign Fibrous / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D018215:Osteoblastoma / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular; D013524:Surgical Flaps; D055815:Young Adult