Resection arthrodesis of the knee for sarcoma: preliminary results

The surgical removal of malignant bone tumors of the knee requires the generous removal of large segments of femur and tibia with large cuffs of surrounding musculature. This type of resection does not leave the necessary muscles and soft tissue for a functioning knee joint, either through the use of a large custom-made total knee replacement or a large cadaver homograft. Arthrodesis of the knee with an intramedullary rod and segmental bone grafting is a method to reconstruct the large defects remaining after this type of resective surgery. The technique may also have good application in the salvage of failed total knee replacements. Fifteen patients have undergone resection of sarcomas in the bones of the knee area followed by reconstruction with an intramedullary rod and grafting of the gap left by the resected sarcoma. Tumor has been controlled locally in all but one case, which involved prior contamination before our treatment of the patient. Twenty-six of the 28 segmental grafts, which averaged 21.6 cm, have gone to primary bone union. There have been two infections, two fractures-one of the graft and one of the donor site-and two patients with excessive shortening of the grafted segment. The limiting factor in the length of the resection possible is the narrow diameter at the isthmus of the femur and length of the fibular graft available. Updated techniques have decreased the incidence of surgical complications. It appears from this study and experimental studies that large autografts will heal in the face of preoperative and postoperative Adriamycin chemotherapy. It is our conclusion that resection arthrodesis of the knee is a functional reconstructive method for patients requiring extensive resection of sarcoma of the mid to distal femur and proximal tibia.