Proximal tibial resections and reconstructions: clinical outcome of 225 patients.
BACKGROUND
Previous studies reported variable outcome of proximal tibial resections and reconstructions. Therefore, we evaluated the survival, Musculoskeletal Tumor Society (MSTS) function, and complications of patients and reconstructions in this location.


METHODS
We reviewed the files of 225 patients with proximal tibial tumors treated with proximal tibial resection, fixed or rotating hinge megaprosthetic reconstruction and extensor mechanism reattachment using sutures, mechanical clamping, artificial ligaments, and/or gastrocnemius flap from 1985 to 2010 (mean follow-up, 90 months; median, 56; range, 2-294). Survival of patients and reconstructions, type of hinge, extensor mechanism reconstruction, MSTS function, and complications were analyzed.


RESULTS
Survival of patients with sarcomas was 68% and 62% at 5 and 10 years. Survival of megaprosthetic reconstructions was 82% and 78% at 5 and 10 years, without any difference between fixed and rotating hinge megaprostheses. MSTS function was significantly better in univariate and multivariate analysis for rotating compared to fixed hinge megaprostheses, without any difference between the types of extensor mechanism reconstructions. Most common complications were infection (12%), aseptic loosening (6%), and extensor mechanism rupture (3%).


CONCLUSIONS
Rotating hinge proximal tibia megaprosthetic reconstructions have better function compared to fixed hinge, regardless of the type of extensor mechanism reconstruction.
Department of Orthopaedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
Andreas F
AF
Mavrogenis
Elisa
E
Pala
Andrea
A
Angelini
Andrea
A
Ferraro
Pietro
P
Ruggieri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D013524:Surgical Flaps; D013526:Surgical Mesh; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome