LIMB SALVAGE WITH CUSTOM MEGA PROSTHESIS IN OSTEOSARCOMA OF PROXIMAL TIBIA

Abstract

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.