Algorithm for the surgical treatment of malignant lesions of the proximal tibia

Complications are common among patients treated for malignant lesions of th e proximal tibia and can be difficult to manage, This investigation was a r etrospective review of 40 patients treated with total knee replacements aft er proximal tibial resections. Various reconstructive methods were used to fix the prosthetic stems, reestablish the extensor mechanism, and provide s oft tissue coverage. Thirty-one patients had adequate followup to allow for review of prosthetic outcome (means, 78 months; range, 25-193 months). Sev en patients died with less than 2 years followup, and two patients had post operative acute infections treated by early amputation to allow chemotherap y to resume promptly. The overall 5-, 8- and 12-year event free prostheses survival rates were 62%, 33%, and 16%, respectively. Prognostic factors for prosthetic survival were analyzed (age, gender, type of excision, type of prosthesis, type of fixation, and percent of bone resected). None were stat istically significant, Patients with less than 40% of the tibia resected ha d better prosthetic survival at 5 years. The durability of uncemented stem fixation exceeded that of cemented stems. Expected survival of prostheses a fter revision was 52% at 8 years. The major cause of limb loss was infectio n, Failure to reconstruct soft tissues satisfactorily caused most failures. Aggressive multistage management of infection is needed. Prosthetic knee r eplacement is most suitable for patients with cancers that require chemothe rapy and for those patients who have short potential survival.