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Introduction Until recent years limb tumours were treated by amputation resulting in loss of function and           psychological burden to patients. With advent of neoadjuvant chemotherapy the scenario has changed. Custom made mega endoprosthesis can be used for limb salvage after  excision of tumor. It has advantages like stability, restoration of functional limb and early rehabilitation. Now it has become the method for limb salvage in treating bone tumors around knee treated by excision. .Aim To evaluate a patient with osteos arcoma of left proximal tibia treated by neoadjuvant chemotherapy followed by tumor excision and limb salvage with custom mega prosthesis(CMP). Materials and methods .   19 year old male patient was diagnosed as a case of               osteosarcoma of left proximal tibia. Management included tumor staging(Enneking), histopathological verification(biopsy), neoadjuvant chemotherapy, determination of              anatomical-mechanical defect, soft tissue status, radiological evaluation of the reference measures of femur and tibia for creation of CMP. The patient underwent tumor excision and custom mega prosthesis reconstruction of lower limb. With 14 months follow up the patient has 120 knee flexion and no prosthesis related complications. Result Excision of tumour and reconstruction of knee with CMP gives back a functional limb for the patient. Conclusion The goal is to achieve           anatomical joint restitution and adequate restoration of limb biomechanics. Such an effect can only be achieved by CMP produced upon the exact three dimensional model of patient's bone.



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Natarajan MV, Prabhakar R, Mohamed SM,Shashidhar R. Management of juxta articular giant cell tumors around the knee by custom mega prosthetic arthroplasty. Indian J Orthop 2007;41:134-8.

Grimer RJ, Carter SR, Pynsent PB. The cost-effectiveness of limb salvage for bone tumours. J Bone Joint Surg Br 1997; 79: 558–61.

Jeys LM, Grimer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 2003: 27: 160–3.

Capanna R, Ruggeri P, Decristofaro R. Complications, their treatment and outcome in 257 cementless megaprostheses. In: Brown KLB, editor. Complications of limb salvage: prevention, management and outcome. Montreal: ISOLS; 1991. p.l47–50.

Quill G, Gitelis S, Morton T, Piasecki P.Complications associated with limb salvage for extremity sarcomas and their management. Clin Orthop 1990; 260: 242–50.

Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with megaprosthesis after bone tumor resection. J Bone Joint Surg Am 2006; 88: 1285–93.

Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153: 106–20.

Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 1995; 77: 1154–65.

Mittermayer F, Windhager R, Dominkus M, Krepler P, Schwameis E, Sluga M, et al. Revision of the Kotz type of tumour endoprosthesis for the lower limb. J Bone Joint Surg Br 2002; 84(3): 401–6.

Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 2006; 450: 164–71.


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