Knee reconstruction with prosthesis and muscle flap after total arthrectomy

A massive prosthesis and medial gastrocnemius muscle transfer were used to reconstruct the knee after extracapsular en blot excision for bone sarcoma, Magnetic resonance images showed intraarticular involvement, This techniqu e was used in nine patients, six men and three women aged 18 to 51 years, w ith primary malignant bone tumors of the knee. Extraarticular resection of the knee, including the patella, was done in every case. A knee prosthesis was implanted, and the extensor mechanism was reconstructed by transfer of the medial gastrocnemius muscle and pes anserinus tendons. All resections h ad negative margins. There were no local recurrences, but metastases occurr ed in two patients. Infection was the only major complication and was seen in two patients. The mean postoperative Musculoskeletal Tumor Society score was 61% (range, 36%-100%), The mean postoperative range of flexion was 62 degrees (range, 30 degrees -90 degrees), and the mean extensor lag was 12 d egrees (range, 0 degrees -40 degrees), Three patients required a crutch to walk, The functional outcome was poor in the two patients whose proximal ti bia was removed with the joint, suggesting that arthrodesis may be best in this situation. In properly selected patients, prosthesis and muscle flap r econstruction provides acceptable function and a good cosmetic result.