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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 10, 1373-1377.
doi: 10.1302/0301-620X.91B10.22076  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation

B. G. I. Spiegelberg, MRCS, MBBS, BSc, Research Fellow1; M. D. Sewell, MRCS, MBBS, Specialist Registrar1; W. J. S. Aston, FRCS(Orth), MBBS, BSc, Specialist Registrar1; G. W. Blunn, PhD, Professor1; R. Pollock, FRCS(Orth), Consultant Orthopaedic Surgeon1; S. R. Cannon, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon1; and T. W. R. Briggs, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon1

1 The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.

Correspondence should be sent to Mr B. G. I. Spiegelberg; e-mail: benspiegelberg{at}doctors.net.uk

This paper describes the preliminary results of a proximal tibial endoprosthesis which spares the knee joint and enables retention of the natural articulation by replacing part of the tibial metaphysis and diaphysis. In eight patients who had a primary malignant bone tumour of the proximal tibia, the distal stem, which had a hydroxyapatite-coated collar to improve fixation, was cemented into the medullary canal. The proximal end had hydroxyapatite-coated extracortical plates which were secured to the remaining proximal tibial metaphysis using cortical screws. The mean age of the patients at operation was 28.9 years (8 to 43) and the mean follow-up was for 35 months (4 to 48). The mean Musculoskeletal Tumour Society score was 79% (57% to 90%), the mean Oxford Knee score was 40 points of 48 (36 to 46) and the mean knee flexion was 112° (100° to 120°). In one patient, revision to a below-knee amputation through the prosthesis was required because of recurrence of the tumour. Another patient sustained a periprosthetic fracture which healed with a painful malunion. This was revised to a further endoprosthesis which replaced the knee.

In the remaining six patients the prosthesis allowed preservation of the knee joint with good function and no early evidence of loosening. Further follow-up is required to assess the longevity of these prostheses.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General