Proximal Tibial Segmental Prosthetic Replacement Without the Use of Muscle Flaps

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Abstract
When doing a proximal tibial prosthetic reconstruction, some surgeons think that the subcutaneous location of the proximal tibia necessitates a gastrocnemius muscle flap for closure and function. In this study, 22 patients with bone tumors had proximal tibial segmental prosthetic replacement using direct reattachment of the patellar tendon to the prosthesis without the use of a muscle flap. Two of 19 patients required reoperation in the postoperative period for hematomas. Both were free of infection or other complications at 24 months mean followup. No other wound complications occurred despite initiation of chemotherapy 2 to 3 weeks after surgery in patients with high-grade malignant tumors (15 of 19). The mean followup was 38.6 months (range, 13–99 months). The patients ranged in age from 15 to 74 years (mean, 39 years). The range of motion achieved postoperatively showed a mean of 97° (±16.3°). All patients had full passive extension with a mean extensor lag of 7.5°. The mean Musculoskeletal Tumor Society score was 27.6 (± 2.0). These results of patients without muscle flaps compare favorably with published results advocating gastrocnemius flaps for the attachment of the patellar tendon to the prosthesis.