Distal tibia resection with endoprosthetic reconstruction in pediatric and adolescent patients with bone sarcomas

Introduction. The incidence of bone sarcomas in the distal tibia is about 5 %. Considering the features of this anatomical area, for a long time amputation was considered the method of choice for local control of the disease. Development of ankle joint endoprostheses in the 1970’s allowed to perform organ-saving surgeries. Data on the effectiveness of this technique in children and teenagers is very sparse and are usually presented as individual observations from large samples.
Aim. To evaluate oncological and functional outcomes of endoprosthesis of the distal tibia and ankle joint with personalized implants in children and teenagers with bone sarcomas and to describe complications (per the Henderson classification) of this surgical intervention.
Materials and methods. The study included 21 patients with ages varying between 8 and 17 years (median age 13.8  ±  3.2 years). All patients received combination treatment. Endoprosthesis of the distal tibia and ankle joint was performed. Functional results were evaluated after 12 months using the Musculoskeletal Tumor Society Score (MSTS) scale. Oncological outcomes were analyzed using the Kaplan–Meier method. All complications were classified per the Henderson system modified by the International Society of Limb Salvage (ISOLS).
Results. In 13 (61.9 %) cases, resection of both tibia and fibula was performed, in all other cases fibula was saved. Median resection length was 15 (8–22.5) cm. Histological examination verified osteosarcoma in the majority of patients, ratio between this pathology and other malignant neoplasms was 2.5:1. Even-free survival in patients with osteosarcoma of the distal tibia was 53 ± 14 %, overall survival was 77 ± 15 %. Functional results were evaluated in 14 patients. Mean score per the MSTS scale was 72 (49–88) %. Complications were reported in 7 (33.3 %) patients.
Conclusion. The data demonstrated effectiveness of endoprosthesis of the distal tibia and ankle joint in children and teenagers with bone sarcomas; good oncological and functional results were achieved.

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