Tips and tricks of limb salvage: Proximal tibia

Abstract

Due to its anatomical location, the upper end of the tibia poses unique problems while attempting limb salvage and appropriate reconstruction. This article attempts to highlight a few of the key steps, pearls and pitfalls while attempting this challenging procedure.

Keywords: Arthrodesis; megaprosthesis; osteosarcoma; proximal tibia.

Figure 1A

Plain radiographs anteroposterior (a) and lateral (b) views and T1-weighted magnetic resonance imaging image (c) showing an osteosarcoma of the upper tibia showing the planned resection length (arrow)

Figure 1B

Clinical photograph showing healed postoperative scar of the anteromedial approach extending from the distal femur to the anteromedial tibia

Figure 1C

Postoperative radiograph of the case shown in Figure 1A with showing prosthesis in situ. Note that the proximal fibula has been excised too

Figure 2

Peroperative photograph showing a “composite” prosthesis that includes a distal femoral and a proximal tibial component

Figure 3

Peroperative photographs showing (a) Ligated stump of anterior tibial artery (arrow) with continuity of the posterior tibial vessels (b) Patellar tendon being anchored to hook on prosthesis. Bone plug wedged under the hook (black arrow). Polypropylene mesh (white arrow) being wrapped around the proximal tibial prosthesis. Harvested medial gastrocnemius muscle flap (arrowhead) (c) Medial gastrocnemius muscle flap brought forward anteriorly to cover the prosthesis

Figure 4

Arthrodesis using a hemicortical autograft from the distal femur (white arrow) turned down to bridge the resultant gap after proximal tibial excision