Modular prosthetic reconstruction for primary bone tumours of the distal tibia in ten patients

Authors

Keywords:

distal tibia, endoprosthetic replacement, osteosarcoma, giant cell tumour, limb salvage, amputation

Abstract

Background: Below-knee amputation (BKA) is the safest treatment for benign aggressive and malignant bone tumours of the distal tibia, yielding good oncological and functional results. However, in selected patients where limb salvage is feasible and amputation unacceptable to the patient, limb salvage using a distal tibial replacement (DTR) can be considered. This study aims to present the oncological and functional results of the use of the latter treatment method in our unit.

Methods: A retrospective folder review was performed for all ten patients who received a modular DTR between 1 January 2005 and 31 January 2019 for a primary bone tumour, either benign aggressive or malignant. Six were female and the mean age was 31 (12–75) years. There were five patients with giant cell tumour of bone, four with osteosarcoma and one with a low-grade chondrosarcoma. The patients with osteosarcoma had neoadjuvant chemotherapy before surgery. Function was assessed by the Musculoskeletal Tumor Society (MSTS) score.

Results: Two patients had local recurrence treated with a BKA and one other patient died of metastases three years postoperatively. At a mean follow-up of three years, the remaining eight patients had a mean MSTS score of 83% (67–93%) There were no radiological signs of loosening, and no revision surgeries.

Conclusion: Endoprosthetic replacement of the distal tibia for primary bone tumours can be a safe treatment option in very selected cases.

Level of evidence: Level 4

Author Biographies

Walid Mugla, University of Cape Town

Sarcoma Unit, Groote Schuur Hospital; Faculty of Medicine and Health Sciences, Department of Surgery, Division of Orthopaedics, University of Cape Town, Cape Town, South Africa

Hendrik C F Bauer, Karolinska Institute

Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; visiting professor in the Faculty of Medicine and Health Sciences, Department of Surgery, Division of Orthopaedics, University of Cape Town, Cape Town, South Africa

Jonathan Vogel, University of Cape Town

Faculty of Medicine and Health Sciences, Department of Surgery, Division of Orthopaedics, University of Cape Town, Cape Town, South Africa

Keith V Hosking, University of Cape Town

Vincent Pallotti Life Orthopaedic Hospital, Cape Town; Faculty of Medicine and Health Sciences, Department of Surgery, Division of Orthopaedics, University of Cape Town, Cape Town, South Africa

Neil Campbell, LRS Implants

LRS Implants, Cape Town, South Africa

Thomas L Hilton, University of Cape Town

Groote Schuur Hospital and Life Vincent Pallotti Orthopaedic Hospital, Cape Town; Faculty of Medicine and Health Sciences, Department of Surgery, Division of Orthopaedics, University of Cape Town, Cape Town, South Africa

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Published

2022-05-19

Issue

Section

Orthopaedic Oncology and Infections