Abstract
This case study describes a total tibia resection and reconstruction with a custom-made endoprosthetic replacement (EPR) and a long-term, 8-year follow-up. The patient underwent a total tibia adamantinoma resection in 2009. Reconstruction was performed with a custom-made total tibia EPR, where both the knee joint and ankle joint were reconstructed. Two muscle flaps, latissimus dorsi free flap and a pedicled medial gastrocnemius flap, were used for soft tissue reconstruction. The patient returned to normal life as a kindergarten teacher, without complications for eight years. This case demonstrated the importance of successful multidisciplinary teamwork in close collaboration with industry. In our best knowledge, no over 2 years of follow-up of total tibia replacement reports have been published.
Highlights
Adamantinoma is a rare malignant bone tumor, accounting for approximately 0.1–0.5% of all primary bone tumors [1]
This study describes a case of complete tibia resection and total tibia custom-made endoprosthetic replacement (EPR), with a long-term followup and functional outcome
In a routine follow-up, in addition to radiographs, we used a local magnetic resonance image (MRI) with a metal artifact reduction sequence (MARS) technique [12], which enables to observe local recurrences of the tumor around the massive titanium endoprosthesis
Summary
Adamantinoma is a rare malignant bone tumor, accounting for approximately 0.1–0.5% of all primary bone tumors [1]. In the literature, reported limb salvage rate for long bone adamantinoma patients is about 84% [3] and amputation compared with the limb preserving surgery has not been proved to improve survival rate [5]. Reconstruction after resection surgery for adamantinoma, in long bones, is dependent on the site and size of tumor. In cases where tumor affects the entire tibia, a wide excision with a clear margin is achievable with knee disarticulation, or higher amputation, or with a total tibia resection and reconstruction. No midterm or long-term results over 2 years of follow-up of total tibia replacement case reports have been published. This study describes a case of complete tibia resection and total tibia custom-made EPR, with a long-term followup and functional outcome. This case study highlights the rarity of the reconstruction, multidisciplinary team work, and the good long-term functional result
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