EVALUATION OF FIBULAR HEAD RESECTION IN PROSTHETIC REPLACEMENT FOR NEOPLASMS OF PROXIMAL TIBIA IN LIMB SALVAGE SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHUXiaobing ^1,2 ,  YEZhaoming ¹

1. Department of Orthopedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P. R. China;
2. Department of Orthopedics, Taizhou Cancer Hospital;

Corresponding?author：

YEZhaoming, Email: yezhaominghz@163.com

Keywords：

Bone tumor; Proximal tibia; Fibular head; Artificial joint; Function reconstruction; Limb salvage surgery

DOI：

10.7507/1002-1892.20150154

Video：

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Objective To investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery. Methods Between July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function. Results All patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ²=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ²=0.106, P=0.744). Conclusion Fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.

Citation： ZHUXiaobing, YEZhaoming. EVALUATION OF FIBULAR HEAD RESECTION IN PROSTHETIC REPLACEMENT FOR NEOPLASMS OF PROXIMAL TIBIA IN LIMB SALVAGE SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 717-720. doi: 10.7507/1002-1892.20150154 Copy

1.	Enneking WE, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, 286(1):241-246.
2.	Wunder JS, Leitch K, Grifin AM, et al. Comparison of two methods of reconstruction for primary malignant tumors at the knee:a sequential cohort study. J Surg Oncol, 2001, 77(2):89-99.
3.	Pl?tz W, RechI H, Burgkart R, et al. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res, 2002, (405):207-215.
4.	Schwartz AJ, Kabo JM, Eilber FC, et al. Cemented endoprosthetic reconstruction of the proximal tibia:how long do they last? Clin Orthop Relat Res, 2010, 468(11):2875-2884.
5.	Donati D, Colangeli M, Colmgeli S, et al. Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res, 2008, 466(2):459-465.
6.	Malawer MM, McHale KA. Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Clin Orthop Relat Res, 1989, (239):231-248.
7.	Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4):842-849.
8.	Brigman B, Hornicek FJ, Gebhardt MC, et al. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421):232-239.
9.	劉燚, 崔志明, 崔勝宇, 等. 人工假體置換在股骨下段骨肉瘤合并病理性骨折保肢治療中的應用. 中國組織工程研究與臨床康復, 2011, 15(43):8038-8041.
10.	Grimer RJ, Carter SR, Tillman RM, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg (Br), 1999, 81(3):488-494.
11.	Dieckmann R, Gebert C, Streitburger A, et al. Proximal fibula resection in the treatment of bone tumors. Int Orthop, 2011, 35(11):1689-1694.
12.	Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula.An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6):806-810.
13.	Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibula osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5):569-573.
14.	Einoder PA, Choong PF. Tumors of the head of the fibula:good function after resection without ligament reconstruction in 6 patients. Acta Orthop Scand, 2002, 73(6):663-666.
15.	Ben Amotz O, Ramirez R, Husain T, et al. Complications related to harvest of the proximal end of the fibula:a systematic review. Microsurgery, 2014, 34(8):666-669.

1. Enneking WE, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, 286(1):241-246.
2. Wunder JS, Leitch K, Grifin AM, et al. Comparison of two methods of reconstruction for primary malignant tumors at the knee:a sequential cohort study. J Surg Oncol, 2001, 77(2):89-99.
3. Pl?tz W, RechI H, Burgkart R, et al. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res, 2002, (405):207-215.
4. Schwartz AJ, Kabo JM, Eilber FC, et al. Cemented endoprosthetic reconstruction of the proximal tibia:how long do they last? Clin Orthop Relat Res, 2010, 468(11):2875-2884.
5. Donati D, Colangeli M, Colmgeli S, et al. Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res, 2008, 466(2):459-465.
6. Malawer MM, McHale KA. Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Clin Orthop Relat Res, 1989, (239):231-248.
7. Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4):842-849.
8. Brigman B, Hornicek FJ, Gebhardt MC, et al. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421):232-239.
9. 劉燚, 崔志明, 崔勝宇, 等. 人工假體置換在股骨下段骨肉瘤合并病理性骨折保肢治療中的應用. 中國組織工程研究與臨床康復, 2011, 15(43):8038-8041.
10. Grimer RJ, Carter SR, Tillman RM, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg (Br), 1999, 81(3):488-494.
11. Dieckmann R, Gebert C, Streitburger A, et al. Proximal fibula resection in the treatment of bone tumors. Int Orthop, 2011, 35(11):1689-1694.
12. Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula.An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6):806-810.
13. Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibula osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5):569-573.
14. Einoder PA, Choong PF. Tumors of the head of the fibula:good function after resection without ligament reconstruction in 6 patients. Acta Orthop Scand, 2002, 73(6):663-666.
15. Ben Amotz O, Ramirez R, Husain T, et al. Complications related to harvest of the proximal end of the fibula:a systematic review. Microsurgery, 2014, 34(8):666-669.

Chinese Journal of Reparative and Reconstructive Surgery

EVALUATION OF FIBULAR HEAD RESECTION IN PROSTHETIC REPLACEMENT FOR NEOPLASMS OF PROXIMAL TIBIA IN LIMB SALVAGE SURGERY

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