Long-term results of individual primary and revision oncological endoprosthetics replacements of ankle joint region with lesions of benign and malignant bone tumors

Introdaction. In the general structure of oncological endoprosthetics, primary lesions of the distal tibia are rarely affected. Endoprosthetics of the ankle joint region are associated with characteristic difficulties consisting in soft tissue deficiency and restoration of the biomechanics of the lost joint. The existing scientific volume of the literature data on primary ankle replacement is insignificant. At the moment, there is no experience and clear strategy in revision endoprosthetics of this area, complications remain insufficiently explored.

Objective. The aim of the study was a discrete analysis of medium- and long-term results, the structure of complications, and functional results in a group of patients after primary and repeated oncological ankle replacement.

Materials and methods. The study included 20 patients with benign and malignant bone tumors, who from July 2008 to November 2019 underwent 33 primary and revision replacements in case of distal tibia tumor lesion. In the study group of patients, 70 % were diagnosed with a primary malignant tumor and 30 % had a benign lesion of the tibia. The mean follow-up period was 58,6 months.

Results. The leading complication after primary and revision endoprosthetics was early aseptic instability (type IIA) – 20,0 and 23,1 %, respectively. Primary and revision endoprosthetics survival after 5 years was 40,1 ± 12 %.

Conclusion. The average functional result after primary and revision ankle replacement was evaluated according to the MSTS scale and after 6 months was 70,5 % and varied from 40 to 87 %. After 12 months, this figure was 76 % and ranged from 46,7 to 96,7 %.

The choice of an endoprosthesis, taking into account the optimal biomechanics design of the endoprosthesis unit, methods of fixation, the introduction of innovative technological solutions in the design, materials of the endoprosthesis, adherence to the principle of radicalism will become a means of reducing the frequency of complications.

1. Алиев М.Д. Эндопротезирование как основа онкоортопедии. Cаркомы костей, мягких тканей и опухоли кожи 2010;4:7–12.

2. Aksnes L.H., Bauer H.C., Jebsen N.L. et al. Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 2008;90(6):786–94.

3. Hwang J.S., Mehta A.D., Yoon R.S., Beeb K.S. From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology. J Orthopaed Traumatol 2014;15:81–6.

4. Grimer R.J., Aydin B.K., Wafa H. et al. Very long-term outcomes after endoprosthetic replacement for malignant tumors of bone. Bone Joint J 2016;98-B:857–64.

5. Pala E., Henderson E.R., Calabro T. et al. Survival of current production tumor endoprostheses: Complications, functional results, and a comparative statistical analysis. J Surg Oncol 2013;108(6):403–8.

6. Алиев М.Д., Соколовский А.В., Соколовский В.А., Сергеев П.С. Результаты реконструкций голеностопного сустава мегапротезом при поражении опухолью дистального отдела большеберцовой кости. Саркомы костей, мягких тканей и опухоли кожи 2010;4:13–8.

7. Kerkhoff Y.R., Kosse N.M., Metsaars W.P., Louwerens J.W. Long-term Functional and Radiographic Outcome of a Mobile Bearing Ankle Prosthesis. Foot Ankle Int 2016;37(12):1292–302.

8. Shekkeris A.S., Hanna S.A., Sewell M.D. et al. Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours. J Bone Joint Surg Br 2009; 91-B:1378–82.

9. Карпенко В.Ю., Бухаров А.В., Курильчик А.А. и др. Эндопротезирование при опухолевом поражении дистальных отделов конечностей. Онкология. Журнал им. П.А. Герцена 2017;6(5):31–6.

10. Zhao Z., Yan T., Guo W. et al. Surgical options and reconstruction strategies for primary bone tumors of distal tibia: A systematic review of complications and functional outcome. J Bone Oncol 2018;14:100209.

11. Yang P., Evans S., Khan Z. et al. Reconstruction of the distal tibia following resection of aggressive bone tumours using a custom-made megaprosthesis. J Orthop 2017;14(3):406–9.

12. Mavrogenis A.F., Abati C.N., Romagnoli C., Ruggieri P. Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma. Clinical Orthopaedics Related Res 2012;470(6):1735–48.

13. Chandrasekar C.R., Grimer R.J., Carter S.R. et al. Malignant Tumours of the Foot and Ankle: Results of Limb Salvage and Amputation. ISOLS 2009.

14. Lohmann C., Beil T., Güthoff W., Rüther W. A. New System of Mega-Endoprostheses for Use in Tumor and Revision Surgery. ISOLS 2007.

15. Lee S.H., Kim H.S., Park Y.B. et al. Prosthetic reconstruction for tumors of the distal tibia and fiula. J Bone Joint Surg Br 1999;81-B:803–7.

16. Shalaby S., Shalaby H., Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fiular graft and Ilizarov external fiator. J Bone Joint Surg Br 2006;88-B:1642–6.

17. Ebeid W., Amin S., Abdelmegid A. et al. Reconstruction of distal tibial defects following resection of malignant tumours by pedicled vascularised fiular grafts. Acta Orthop Belg 2007;73:354–9.

18. Abudu A., Grimer R.J., Tillman R.M., Carter S.R. Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours. Int Orthop 1999;23:291–4.

19. Natarajan M.V., Annamalai K., Williams S. et al. Limb salvage in distal tibial osteosarcoma using a custom mega prosthesis. Int Orthop 2000;24:282–4.