Endoprosthetic replacement of the proximal tibia

We have performed endoprosthetic replacement after resection of tumours of the proximal tibia on 151 patients over a period of 20 years. During this p eriod limb-salvage surgery was achieved in 88% of patients with tumours of the proximal tibia. Both the implant and the operative technique have been gradually modified in order to reduce complications. An initial rate of inf ection of 36% has been reduced to 12% by the use of a flap of the medial ga strocnemius, to which the divided patellar tendon is attached. Loosening an d breakage of the implant have been further causes of failure. We found tha t the probability of further surgical procedures being required was 70% at ten years and the risk of amputation, 25%. The development of a new rotatin g hinge endoprosthesis may lower the incidence of mechanical problems. Limb salvage for tumours of the proximal tibia is fraught with complication s, but the good functional outcome in successful cases justifies its contin ued use.