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Bone Tumors and Orthopedics

(P 99) LIMB SALVAGE FOR PROXIMAL TIBIA TUMORS: OUTCOMES OF ALLOGRAFT-PROSTHESIS COMPOSITE AND ENDOPROSTHETIC RECONSTRUCTION

    Author(s)

  • Nikola Susic, B.S.

    Medical Student
    University of Miami Miller School of Medicine
    Coral Gables, Florida, United States

    • Co-Author(s)

  • TA

    Taha Aksoy, MD

    Department of Orthopaedics, University of Miami
    Miami, Florida, United States

  • LT

    Levi Travis, B.S.

    University of Miami
    Miami, Florida, United States

  • EG

    Erik J. Geiger, MD

    Orthopaedic Oncologist
    University of Miami
    Miami, Florida, United States

  • FH

    Francis J. Hornicek, Jr., MD, PhD

    Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Miller School of Medicine, University of Miami, Miami, FL, USA
    Miami, Florida, United States

  • HT

    H.T. Temple, MD

    Professor of Orthopedic Surgery, oncologist
    1.University of Miami , Miller School of Medicine, Department of Orthopedic Surgery
    Miami, Florida, United States

  • BC

    Brooke Crawford, MD

    Department of Orthopaedics, University of Miami
    Miami, Florida, United States

Objective: The proximal tibia (PT), one of the most common sites for primary bone tumors, poses reconstruction challenges due to limited soft-tissue coverage and extensor mechanism repair. Reconstruction options include endoprosthetic (EP) and allograft-prosthesis composites (APC), with each method facing high failure rates. This study compares APC and EP outcomes, including failure characteristics, functional recovery, and predictors of failure.

Methods: With Institutional Review Board approval, records of patients who underwent proximal tibia reconstruction (2009–2024) were retrospectively reviewed. Demographic, clinical, radiographic, and surgical data were analyzed using Mann-Whitney U, Chi-square tests, Fisher’s exact test, and univariate and multivariate logistic regression.

Results: Thirteen patients underwent APC (mean age: 32.3 ± 17.3) and 38 underwent EP reconstruction (mean age: 37.6 ± 21.2). Prosthetic failure occurred in 6 (46.2%) APC patients and 18 (47.4%) EP patients (p = 0.999). Time and type of failure did not differ between groups (Table 1). Radiographic analysis showed no differences in zone of radiolucency (ZOR) or cortical expansion remodeling (p > 0.05). All patients with aseptic loosening had a ZOR ≥ 2 (p=0.002). Functional recovery was similar between groups (p > 0.05). ZOR (OR [95% CI] = 2.10 [1.26–3.50], p= 0.005), age at follow up (OR [95% CI] = 1.03 [1.00–1.06], p= 0.026) and length of follow up (OR [95% CI] = 1.13 [1.01–1.27], p= 0.027) to be associated with failure on univariate analysis. Multivariate regression showed no significant predictors of failure.

Conclusion: APC and EP showed comparable clinical outcomes and failure rates. Aseptic loosening was associated with ZOR ≥ 2, and ZOR may predict prosthetic failure but could be confounded by age and follow-up duration. APC offers potential benefits in extensor mechanism reinforcement and bone stock restoration, while EP avoids allograft risks, allows soft-tissue closure, and enables immediate weight bearing. Larger multicenter studies and validated functional assessments (e.g., PROMIS, MSTS) are needed to inform individualized reconstruction strategies.

Table 1. Prosthetic Failure Characteristics
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