Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours

Below knee amputation remains the treatment of choice for most patients wit h aggressive tumours of the distal tibia. We report the clinical and functi onal outcome of limb preserving surgery and endoprosthetic reconstruction o f the distal tibia and ankle joint in five patients who declined amputation . The mean age was 32 years. Two had osteosarcoma, one Ewing's sarcoma, lei omyosarcoma and Giant cell tumour. Three patients developed significant com plications including local recurrence, wound dehiscence and infection, and fibula impingement. Despite these complications the patients declined amput ation even in the presence of significant discomfort. Early function was ex cellent in all patients but deteriorated with time. The patients still main tained an Enneking Score of more than 50%. Some patients are unwilling to u ndergo amputation for aggressive tumours of the distal tibia. For these, ex cision and reconstruction with endoprosthesis allow early functional recove ry but there is significant medium term morbidity and functional deteriorat ion.