Knee joint reconstruction with modular-megaprosthesis following peri-articular tumour resection and mutilating trauma: Sri Lankan perspective on limb salvage surgery

Abstract

amount of bone resected, is the most popular & readily available option for limb salvage surgery in the world. MMP can be used for reconstruction of the knee joint where the use of regular prosthesis would be impossible following peri-articular tumour resection and mutilating trauma due to greater degree of bone loss and extensive ligament damage or excision. MMP is yet an emerging concept in Sri lankan setup due to many obstacles in implementing limb salvage surgery. Methods: Six consecutive patients underwent Total Knee Arthroplasty(TKA) with MMP in SJP General Hospital within the period of 31/06/2009--31/08/2012. Primary pathology, operative details, complications following surgery and in subsequent follow-up was analyzed. Knee-Society-Knee-Score-(KSKS) determined the functional outcome of the surgery. Results: Six TKAs were for wide local excision of lower femoral osteosarcomas(n=2), chondrosarcoma(n=1) & a Giant cell tumour(n=1) with a Extensive knee trauma(n=1) and a periprosthetic fracture of previous primary TKA(n=1). Range of follow up duration was(6–24 months). No intra operative or immediate post operative complications were detected. Excellent outcome (Knee-Society-Knee-Score 80 -100) reported in all, except for the patient who underwent TKA following extensive trauma. He subsequently developed a flexion contracture with a peri-prosthetic wound infection. Conclusion: Knee joint reconstruction with MMP is a successful option in periarticular tumor resection or mutilating trauma involving the knee joint which may salvage the limb preserving a good functional outcome despite extensive ligament and bone loss.