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Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement
J Bickels1, J C Wittig, Y Kollender
1Department of Orthopaedic Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010.
The Journal of Arthroplasty
|October 19, 2001
Summary
Reconstructing the extensor mechanism after proximal tibia tumor resection using prosthetics, bone grafts, and muscle flaps is effective. This approach reliably restores knee extension and function in most patients.
Area of Science:
- Orthopedic Surgery
- Oncology
- Reconstructive Surgery
Background:
- Proximal tibia bone tumor resection presents challenges due to proximity to neurovascular structures.
- Reconstructing the extensor mechanism is critical for functional outcomes after proximal tibia endoprosthetic reconstruction.
- Inadequate soft tissue coverage complicates endoprosthetic reconstruction in the proximal tibia.
Purpose of the Study:
- To evaluate the reliability of a specific technique for reconstructing the extensor mechanism after proximal tibia resection.
- To assess functional outcomes and complication rates associated with proximal tibia endoprosthetic reconstruction.
Main Methods:
- Retrospective review of 55 patients undergoing proximal tibia resection and endoprosthetic reconstruction (1980-1997).
- Extensor mechanism reconstruction involved patellar tendon reattachment to prosthesis with Dacron tape, autologous bone graft reinforcement, and gastrocnemius flap coverage.
- Minimum 2-year follow-up to assess functional outcomes and complications.
Main Results:
- 87% of patients achieved good to excellent function.
- 44 patients achieved full extension with an extension lag of 20 degrees or less.
- Complications included transient peroneal nerve palsy (11%), flap necrosis (7.2%), and deep wound infection (3.6%).
Conclusions:
- Patellar tendon reattachment to the prosthesis, reinforced with autologous bone graft and a gastrocnemius flap, is a reliable method.
- This reconstructive strategy effectively restores knee extension after proximal tibia endoprosthetic surgery.
- The described technique yields favorable functional outcomes with manageable complication rates.
