Custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved

The therapeutic results of managing proximal tibial osteosarcoma have been dramatically improved because of the recent advancements in imaging, chemotherapy, and surgical techniques. Further, the prognosis of patients with proximal tibial osteosarcoma is improved and the chance of survival with limb salvage surgery is increased. Among the limb salvage procedures, endoprosthetic reconstruction is now preferred to other methods such as allograft, composite allograft prosthesis, or arthrodesis. However, the treatment for proximal tibial osteosarcoma with proximal tibiofibular joint involved has not been reported.

The report of the preliminary results of custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved following the primary tumor resection. The oncological results, functional outcomes, and complications were assessed in this present study.

Eleven patients with osteosarcoma of the proximal tibia and proximal tibiofibular joint were studied in 1995-2005, at Qilu Hospital of the Shandong University. Seven cases were males and four cases were females, with a mean age of 17 years (range 14-23). The surgical stage of all of the patients was Stage IIB, according to the Enneking Surgical Staging System. After neo-adjuvant chemotherapy, all of the patients underwent en bloc resection. This procedure included the proximal tibiofibular joint and the upper end of the fibula, followed by custom prosthetic replacement. The extensor mechanism was repaired by reattachment of the patellar tendon to the slot in the tibial component, with reinforcement by autologous bone-graft and suturing of the patellar tendon to a medial gastrocnemius rotation flap. The medial gastrocnemius rotation flap was then used to cover the implants.

During the mean follow-up time of 47 months (range 12-96), six patients lived free of the disease, and five patients experienced various complications. One patient was still alive yet affected by the disease; one patient had an amputation due to local recurrence; and three died of pulmonary metastases. Several early complications had occurred amongst those five patients: one developed skin necrosis; two experienced transient palsy of the common peroneal nerve; and two developed deep vein thrombus of the lower limb. The mean Musculoskeletal Tumor Society score was 70% (range 55-86%), the mean postoperative range of motion was 85 degrees (range 0-120 degrees ), and the mean extension lag was 11 degrees (range 0-20 degrees ).

Custom prosthetic reconstruction could yield as much satisfactory results as neoadjuvant chemotherapy and limb salvage surgery, for patients with osteosarcoma in proximal tibia and proximal tibiofibular joint. During the present study, most patients had good or excellent motor functioning with few incidences of complications. However, more attention should have been given to both the quality of function and long-term survival of patients.