Different reconstructive techniques for tumours of the distal tibia

Area of Science:

• Orthopedic Surgery
• Oncology
• Reconstructive Surgery

Background:

• Distal tibial bone tumors present complex reconstructive challenges.
• Limb-sparing surgery aims to preserve function while removing tumors.
• Multiple reconstruction techniques exist, each with potential benefits and drawbacks.

Purpose of the Study:

• To compare the outcomes of three distal tibial bone tumor reconstruction methods: intercalary resection and reconstruction, osteoarticular reconstruction, and ankle arthrodesis.
• To evaluate complication rates and functional scores associated with each technique.

Main Methods:

• Retrospective, multicenter study of 73 patients with distal tibial bone tumors.
• Patients underwent intercalary resection (17), osteoarticular reconstruction (11), or ankle arthrodesis (45).
• Median follow-up was 77 months; outcomes assessed included local recurrence, complications, and functional scores (MSTS, AOFAS).

Main Results:

• Local recurrence occurred in 8 patients, unrelated to margins or technique.
• Major complications included graft fracture (10), osteotomy nonunion (7), and infection (5).
• Intercalary reconstruction yielded higher Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to other methods.

Conclusions:

• Preserving the epiphysis through joint-sparing resection is a safe and effective limb-sparing strategy for distal tibial tumors, requiring meticulous preoperative planning.
• When joint-sparing is not feasible, ankle arthrodesis is generally preferred over osteoarticular reconstruction.
• While osteoarticular reconstruction can preserve the joint, it carries a risk of severe osteoarthritis, potentially necessitating conversion to arthrodesis.