Surgical treatment of skeletal metastases in proximal tibia: a multicenter case series of 74 patients

Kaarel Kilk; Jessica Ehne; Jonathan D Stevenson; Gilber Kask; Jyrki Nieminen; Rikard Wedin; Michael C Parry; Minna K Laitinen

doi:10.1080/17453674.2020.1866242

Authors

Kaarel Kilk Department of Orthopaedics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
Jessica Ehne Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
Jonathan D Stevenson Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK
Gilber Kask Department of Orthopaedics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
Jyrki Nieminen Coxa, Hospital for Joint Replacement, Tampere, Finland
Rikard Wedin Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
Michael C Parry Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK; Aston University Medical School, Aston University, Birmingham, UK
Minna K Laitinen Department of Orthopaedics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

DOI:

https://doi.org/10.1080/17453674.2020.1866242

Abstract

Background and purpose — The proximal tibia is a rare site for metastatic bone disease and is a challenging anatomi- cal site to manage due to the proximity to the knee joint and poor soft tissue envelope. We investigated implant survival and complications of different surgical strategies in the treatment of proximal tibia pathological fractures.

Patients and methods — The study comprised a 4 medical center, retrospective analysis of 74 patients surgically treated for metastases of the proximal tibia. Patient records were reviewed to identify outcome, incidence, and type of complications as well as contributing factors.

Results — Reconstruction techniques comprised cement- augmented osteosynthesis (n = 33), tumor prosthesis (n = 31), and total knee arthroplasty with long cemented stems (n = 10). Overall implant survival was 88% at 6 months and 1 year, and 67% at 3 years. After stratification by tech- nique, the implant survival was 82% and 71% at 1 and 3 years with tumor prosthesis, 100% at 1 and 3 years with total knee arthroplasty, and 91% at 1 year and 47% at 3 years with osteosynthesis. Preoperative radiotherapy decreased implant survival. Complications were observed in 19/74 patients. Treatment complications led to amputation in 5 patients.

Interpretation — In this study, the best results were seen with both types of prothesis reconstructions, with good implant survival, when compared with treatment with osteo- synthesis. However, patients treated with tumor prosthesis showed an increased incidence of postoperative infection, which resulted in poor implant survival. Osteosynthesis with cement is a good alternative for patients with short expected survival whereas endoprosthetic replacement achieved good medium-term results.