Treatment of metastatic disease to the tibia, ankle, and foot

Abstract

Skeletal metastatic disease to the lower extremity is rare. However, when it does happen it is a source of significant morbidity to the patient. The orthopaedic surgeon must be acutely cognizant of the need to prevent or treat fractures and provide immediate and full weight bearing for these patients. Anatomic considerations must be considered, and different treatment modalities are used based on where the metastatic lesion is located. Surgical management of metastatic foci distal to the knee include curettage with cement or bone graft augmentation and stabilization, en bloc resection with reconstruction, and amputation. Regardless of what construct is used, the reconstruction should be expected to last for the lifetime of the patient with minimal possibility of local recurrence or progression. For this reason, biologic considerations must be made. Surgical treatment options for metastases from highly aggressive tumors should be kept simple and allow for immediate weight bearing whereas those from more indolent tumors should focus on ensuring the longevity of the construct. Adjuvants such as bisphosphonates or chemotherapeutic agents can be used and added to the bone cement at time of surgery.