Abstract
Between 1993 and 2002, we treated 43 patients with malignant musculoskeletal tumours of the knee region. All patients had partial resection of the femur or tibia together with endoprosthetic replacement. We were able to follow-up 23 patients with an average follow-up of 30 (12–97) months. Complications occurred in ten cases, of which one was a case of local recurrence. Most of the patients were completely satisfied with their condition, with a decreased walking distance as the only notable restriction. There was no correlation between the functional outcome and life quality assessment and the type of the implanted prosthesis, length of resected bone and type of resection. However, patients with tumours in the distal femur had significantly better functional and life quality outcome than those with a proximal tibial tumour.
Résumé
Entre 1993 et 2002 nous avons traité 43 malades avec une tumeur musculo-squelettique maligne de la région du genou. Tous les malades avaient une résection partielle du fémur ou du tibia avec remplacement prothétique. Nous avons suivi 23 malades avec un délai moyen de 30 (12–97) mois. Des complications se sont produites dans 10 cas dont une récidive locale. La plupart des malades ont été satisfaits du résultat avec un périmètre de marche diminué comme seule restriction notable. Il n’y avait aucune corrélation entre, d’une part les résultats fonctionnels et la qualité de vie et, d’autre part, le type de résection, la longueur de résection osseuse et le type de prothèse implantée. Cependant, les malades avec une tumeur du fémur distal avaient de meilleurs résultats pour la fonction et la qualité de vie que ceux atteints d’une tumeur du tibia proximal
Full Text
The Full Text of this article is available as a PDF (150.0 KB).
References
- 1.Anract P, Missenard G, Jeanrot C, Dubois V, Tomeno B. Knee reconstruction with prosthesis and muscle flap after total arthrectomy. Clin Ortop. 2001;384:208–216. doi: 10.1097/00003086-200103000-00024. [DOI] [PubMed] [Google Scholar]
- 2.Boyle M, Tebbi CK, Mindell ER, Mettlin CJ. Adolescent adjustment to amputation. Med Pediatr Oncol. 1982;10:301–312. doi: 10.1002/mpo.2950100312. [DOI] [PubMed] [Google Scholar]
- 3.Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;88:63–69. doi: 10.1302/0301-620x.80b1.7859. [DOI] [PubMed] [Google Scholar]
- 4.Enneking WF. Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In: Enneking WF, editor. Limb salvage in musculoskeletal oncology. New York: Churchill Livingstone; 1987. pp. 626–639. [Google Scholar]
- 5.Gebhardt MC, Flugstad DI, Spigfield DS, Mankin HJ. The use of bone allograft for limb salvage in high grade extremity osteosarcoma. Clin Ortop. 1991;270:181–196. [PubMed] [Google Scholar]
- 6.Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 1999;81:488–494. doi: 10.1302/0301-620x.81b3.9234. [DOI] [PubMed] [Google Scholar]
- 7.Harris IE, Leff AR, Gitelis S, Simon M. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990;72:1477–1483. [PubMed] [Google Scholar]
- 8.Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. J Bone Joint Surg Am. 1999;81:462–467. doi: 10.2106/00004623-199904000-00003. [DOI] [PubMed] [Google Scholar]
- 9.Holzer G, Windhager R, Kotz R. One-stage revision surgery for infected megaprosthesis. J Bone Joint Surg Br. 1997;79:31–35. doi: 10.1302/0301-620x.79b1.7139. [DOI] [PubMed] [Google Scholar]
- 10.Horowitz SM, Lane JM, Otis JC, Healey JH. Prosthetic arthroplasty of the knee after resection of a sarcoma in the proximal end of the tibia. J Bone Joint Surg Am. 1991;73:286–293. [PubMed] [Google Scholar]
- 11.Ilyas I, Yuonge D, Pant R, Moreau P. Limb salvage for proximal tibial tumours using a modular prosthesis. Int Orthop. 2000;24:208–211. doi: 10.1007/s002640000158. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Malawer MM, McHale KA. Limb-sparing surgery for high-grade malignant tumors of the proximal tibia: surgical technique and a method of extensor mechanism reconstruction. Clin Ortop. 1989;239:231–248. [PubMed] [Google Scholar]
- 13.Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT. Prosthetic replacement of the distal femur for primary bone tumours. J Bone Joint Surg Br. 1991;73:762–769. doi: 10.1302/0301-620X.73B5.1894662. [DOI] [PubMed] [Google Scholar]
- 14.Sanjay BKS, Moreau PG. Limb salvage surgery in bone tumour with modular endoprosthesis. Int Orthop. 1999;23:41–46. doi: 10.1007/s002640050301. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Szendrői M, Antal I, Kiss J. Howmedica tumor endoportézissel (HMRS) szerzett tapasztalatok. Magy Traumatol Ortop. 2003;2:122–129. [Google Scholar]
- 16.Wirganovicz PZ, Eckhardt JE, Dorey FJ, Eilber FR, Kabo JM. Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Ortop. 1999;358:64–74. [PubMed] [Google Scholar]
- 17.Zwart HJJ, Taminiau AHM, Schimmel JW, Horn JR. Kotz modular femur and tibia replacement: 28 tumor cases followed for 3 (1–8) years. Acta Orthop Scand. 1994;65:315–318. doi: 10.3109/17453679408995460. [DOI] [PubMed] [Google Scholar]