The Journal of Bone and Joint Surgery (American). 2009;91:1646-1656.
doi:10.2106/JBJS.G.01542
© 2009 The Journal of Bone and Joint Surgery, Inc.
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 Oncology Test 8: Winter 2010 (publication date February 16, 2010; expiratio...
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Allograft-Prosthetic Composite Reconstruction of the Proximal Part of the Tibia

An Analysis of the Early Results*

Nathan F. Gilbert, MD1, Alan W. Yasko, MD2, Scott D. Oates, MD1, Valerae O. Lewis, MD1, Christopher P. Cannon, MD1 and Patrick P. Lin, MD1

1 Departments of Orthopaedic Oncology—Unit 408 (N.F.G., V.O.L., C.P.C., and P.P.L.) and Plastic Surgery—Unit 443 (S.D.O.), The University of Texas M.D. Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230. E-mail address for P.P. Lin: plin{at}mdanderson.org
2 Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Chicago, IL 60611

Investigation performed at The University of Texas M.D. Anderson Cancer Center, Houston, Texas

* Read at the International Symposium on Limb Salvage, Hamburg, Germany, September 13, 2007.

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Stryker) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Allograft-prosthetic composite reconstruction of the proximal part of the tibia is one option following resection of a skeletal tumor. Previous studies with use of this technique have found a high prevalence of complications, including fracture, infection, extensor mechanism insufficiency, and loosening. To address some of these problems, we adopted certain measures, including muscle flap coverage, meticulous tendon reconstruction, rigid implant fixation, and careful rehabilitation. The goal of the present study was to evaluate the functional outcome and complications in patients undergoing allograft-prosthetic composite reconstruction of the proximal part of the tibia.

Methods: Twelve patients who underwent allograft-prosthetic composite reconstruction of the proximal part of the tibia after tumor resection were retrospectively evaluated at a median follow-up of forty-nine months. Clinical records and radiographs were reviewed to evaluate patient outcome, healing at the allograft-host junction, function, construct survival, and complications.

Results: Nine patients had no extensor lag, and three patients had 5° to 15° of extensor lag. The mean amount of knee flexion was 103° (range, 60° to 120°). The mean Musculoskeletal Tumor Society score was 24.3 (81%) of a maximum of 30. Complete bone union occurred in nine patients, and partial union occurred in three patients. At the time of writing, no secondary bone-grafting procedures had been required to achieve union, and no revision or removal of the reconstruction had been performed. Rotational or free flaps provided satisfactory wound coverage in all patients. A deep infection occurred in one patient whose allograft and prosthesis were successfully retained after treatment with surgical débridement and intravenous antibiotics.

Conclusions: After osteoarticular resection of destructive tumors of the proximal part of the tibia, an allograft-prosthetic composite reconstruction can provide consistently good functional results with an acceptably low complication rate. Technical aspects of the procedure that may favorably affect outcome include soft-tissue coverage with muscle flaps and rigid fixation with a long-stemmed implant.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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