Proximal tibial resection and prosthetic reconstruction

Proximal tibia resection with endoprosthetic reconstruction is a complex limb sparing procedure for tumors of the proximal tibia. Recent advances in implants and surgical techniques have made this option preferable to amputation for many patients. Long-term survival and recurrence rates are similar between limb salvage and limb ablation in the proximal tibia. Appropriate indications for limb salvage are imperative to mitigate disastrous outcomes such as loss of limb or life. A comprehensive perioperative evaluation should include a detailed history and physical, laboratory, and radiographic testing, along with a biopsy confirmed diagnosis before the definitive procedure. Once a patient has been appropriately evaluated, there are three steps critical to a successful procedure: proximal tibia resection, reconstruction of the proximal tibia and knee joint with a prosthetic component, and extensor mechanism reconstruction utilizing a gastrocnemius flap to improve implant coverage and enhance the patellar tendon repair. Proximal tibia resection with prosthetic reconstruction can be associated with significant complications; however, these can be minimized with appropriate preoperative planning and a meticulous technique.