Aseptic Loosening is Uncommon with Uncemented Proximal Tibia Tumor Prostheses

Aseptic loosening is a frequent cause of failure of cemented proximal tibia tumor endoprostheses. Uncemented prostheses may lessen this risk. We identified complications including aseptic loosening that affected prosthetic survival, limb survival and functional outcome for 44 consecutive patients after sarcoma resection from the proximal tibia and uncemented endoprosthetic reconstruction. At a mean final followup of 60 months (range, 9-152 months), there were no cases of aseptic loosening. Twelve (27%) patients suffered 14 complications leading to prosthetic failure due to infection (n = 7), stem fracture (n = 2), rotational instability (n = 1), vascular compromise (n = 2) and local tumor relapse (n = 2). However, limb salvage was successful in 37 of 44 (84%) patients. Functional assessment for 35 patients revealed a mean Toronto Extremity Salvage Score of 77/100 (range, 33-98) and Musculoskeletal Tumor Society 1987 and 1993 scores of 25/35 (range, 13-31) and 75/100 (range, 33-97), respectively. Mean knee joint flexion was 91° (range, 0-110°) and knee extension lag was 6° (range, 0-30°). Three patients with knee extensor complications had inferior functional outcomes. Aseptic loosening is uncommon with uncemented proximal tibia reconstruction, but decreasing other complications at this location remains challenging.

Level of Evidence: Therapeutic study, level IV-1 (case series). See Guidelines for Authors for a complete description of levels of evidence.