[Limb salvage with osteoarticular allografts after resection of proximal tibia bone]

To evaluate the short-term efficacy of osteoarticular allografts in the limb salvage of the proximal tibia.

From 1998 to 2003, 15 patients (7 males, 8 females; aged 14-56 yr. average 33) with bone tumor of the proximal tibia underwent osteoarticular allografts. among whom 7 had progressive giant cell tumor without any previous chemotherapy; 8 had malignant tumor with previous chemotherapy, including 6 patients with osteosarcoma, 1 with spindle cell sarcoma, and 1 with malignant fibrous histiocytoma. According to the Enneking system, the patients were classified into I B (7 patients), II A (2 patients), and II B (6 patients). All the patients underwent the marginal resection with an allograft (average length 12 cm, range 6-16 cm) implanted.

The follow-up for an average of 21 months (range, 3-58 months) revealed that among the 8 patients with malignant tumor of the proximal tibia undergoing chemotherapy, 5 had union of the bone, 3 had no union of the bone; among the 3 patients, 2 had a complication of infection and 1 had a local recurrence. All the 3 patients underwent amputation at the lower part of the femur. According to the Mankin score, 2 patients had a perfect result, 2 good, 1 fair, and 3 poor, with a 50% effectiveness rate. Among the 7 patients with progressive giant cell tumor at the upper part of the tibia, none had infection or local recurrence, but 2 had nonunion of the bone and 2 had joint instability, aided by the knee-aiding system. According to the Mankin score, 3 patients had a perfect result, 2 good, and 2 fair, with a 71% effectiveness rate.

The osteoarticular allograft of the proximal tibia has many advantages in spite of a relatively high rate of complications, and it is the limb salvage of choice for the progressive benign or malignant bone tumors of the proximal tibia.