Soft tissue reconstruction of tumor-related proximal tibial hemiarthroplasty using synthetic mesh combined with a medial gastrocnemius flap

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PURPOSE: This study was to evaluate the efficacy of soft tissue reconstruction using synthetic mesh and a medial gastrocnemius flap in patients who underwent proximal tibial hemiarthroplasty after resection of proximal tibial bone sarcomas. METHODS: A retrospective cohort study was conducted on 102 skeletally immature children (58 males, 44 females) who underwent proximal tibial Hemiarthroplasty between January 2005 and December 2023. The most common diagnoses were osteosarcoma (95%), Ewing's sarcoma (4%), and chondrosarcoma (1%). The mean age was 11 years (7-14 years) and the mean follow-up was 85 months (12-233 months). We reported complications according to the modified Henderson classification. The functional outcomes were evaluated by Musculoskeletal Tumour Society Score (MSTS-93) and the Toronto Extremity Salvage Score (TESS). RESULTS: Patients in the combined reconstruction group had higher MSTS-93 and TESS scores (MSTS-93, 83% versus 72%, p = 0.023; TESS, 85% versus 74%, p = 0.041). The mean 2-year postoperative Insall-Salvati ratio (ISR), the Blackburne-Peel index (BPI), and the Caton-Deschamps index (CDI) for patients who underwent combined reconstruction were 1.18 ± 0.32, 0.98 ± 0.22, and 1.21 ± 0.28, respectively. While, The mean 2-year postoperative ISR, BPI, and CDI of patients without combined reconstruction were 1.42 ± 0.39, 1.25 ± 0.29, and 1.61 ± 0.41, respectively (p < 0.05). The combined reconstruction group had a lower mean extensor lag (4.3° versus 11.3°, p < 0.001). In total, 33 patients had at least one complication and 27 patients underwent surgical revision, including 13 infections, 8 local recurrences, 3 soft tissue failures, 2 aseptic loosening, and 1 implant failure. The combined reconstruction group had a lower rate of knee dislocation (2.7% versus 21.4%, p = 0.002). CONCLUSIONS: Soft tissue reconstruction of the proximal tibia using synthetic mesh combined with a medial gastrocnemius flap improves the postoperative efficacy of tumor-related proximal hemiarthroplasty and is expected to reduce the incidence of postoperative knee dislocation and periprosthetic infection. LEVEL OF EVIDENCE: Level III case control study.

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