Limb salvage is now customary in the treatment of primary bone tumours, The
proximal tibia is a frequent site for these neoplasms but reconstruction,
especially in children, is a formidable challenge. We reviewed 20 children
with extendible replacements of the proximal tibia, all with a minimum foll
ow-up of five years. Five died from their disease and, of the remaining 15,
four had above-knee amputations for complications. Infection occurred in s
even patients; in five it was related to the lengthening procedure. Aseptic
loosening is inevitable in the younger children and only two have avoided
a revision, amputation or other major complication; both were aged 12 years
at the time of the initial surgery. Despite this, 11 children are alive wi
th a functioning leg and a mean Musculoskeletal Tumour Society functional s
core of 83%. The lengthening mechanisms used in our series required extensi
ve open operations, We are now using a simpler, minimally invasive, techniq
ue which we hope will decrease the incidence of complications. At present,
the use of extendible prostheses of the proximal tibia remains an experimen
tal procedure.