Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Musculoskeletal Oncology

Background:

• Bone tumors in the proximal tibia often necessitate joint-preserving procedures.
• Total knee replacement (TKR) prostheses and osteochondral allografts (AL) are utilized to maintain knee function.
• Objective comparison of these reconstructive methods is crucial for optimizing patient outcomes.

Purpose of the Study:

• To objectively compare the functional results of total knee modular megaprosthesis versus osteochondral allografts in patients with proximal tibia bone tumors.
• To evaluate gait analysis, muscular strength, and radiographic outcomes between the two treatment groups.

Main Methods:

• Comparative study involving 18 patients: 10 treated with TKR and 8 with AL.
• Objective assessments included X-rays, muscular strength measurements, and gait analysis with electromyography (EMG).
• Functional outcomes were analyzed to compare the efficacy of each reconstructive technique.

Main Results:

• The TKR group exhibited a higher incidence of knee extension lag and reduced rectus femoris activity, indicating abnormal knee patterns.
• Knee extensor muscular strength was significantly reduced in the TKR group.
• While the AL group showed a higher percentage of normal knee patterns, issues like short patellar tendon and joint mismatching were noted.

Conclusions:

• Total knee megaprostheses in this context often lead to abnormal gait and impaired knee extensor function.
• Osteochondral allografts, when optimally reconstructed, provide superior functional results and a higher rate of normal walking patterns.
• Optimal reconstruction techniques are key for achieving better functional outcomes with allografts.