Aims. The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs). Methods. This was a retrospective analysis of clinical data relating to patients who underwent proximal tibial arthroplasty in our regional bone tumour centre from 2010 to 2018. Results. A total of 76 patients fulfilled the inclusion criteria and were included in the study. Mean age at surgery was 43.2 years (12 to 86 (SD 21)). The mean follow-up period was 60.1 months (5.4 to 353). In total 21 failures were identified, giving an overall failure rate of 27.6%. Prosthesis survival at five years was 75.5%, and at ten years was 59%. At last follow-up, mean knee flexion was 89.8° (SD 36°) with a mean extensor lag of 18.1° (SD 24°). In univariate analysis, factors associated with better survival of the prosthesis were a malignant or metastatic cancer diagnosis (versus benign), with a five- and ten-year survival of 78.9% and 65.7% versus 37.5% (p = 0.045), while in-hospital length of stay longer than nine days was also associated with better prognosis with five- and ten-year survival rates at 84% and 84% versus 60% and 16% (p < 0.001). In multivariate analysis, only in-hospital length of stay was associated with longer survival (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.08 to 0.66). Conclusion. We have shown that proximal tibial arthroplasty with endoprosthesis is a safe and reliable method for reconstruction in patients treated for orthopaedic oncological conditions. Either modular or custom implants in this series performed well. Cite this article: Bone Jt Open 2022;3(9):733–740

We studied the bone mineral density (BMD) and the bone mineral content (BMC) of the proximal tibia in patients with a well-functioning uncemented Oxford medial compartment arthroplasty using the Lunar iDXA bone densitometer. Our hypothesis was that there would be decreased BMD and BMC adjacent to the tibial base plate and increased BMD and BMC at the tip of the keel. There were 79 consecutive patients (33 men, 46 women) with a mean age of 65 years (44 to 84) with a minimum two-year follow-up (mean 2.6 years (2.0 to 5.0)) after unilateral arthroplasty, who were scanned using a validated standard protocol where seven regions of interest (ROI) were examined and compared with the contralateral normal knee. All had well-functioning knees with a mean Oxford knee score of 43 (14 to 48) and mean Knee Society function score of 90 (20 to 100), showing a correlation with the increasing scores and higher BMC and BMD values in ROI 2 in the non-implanted knee relative to the implanted knee (p = 0.013 and p = 0.015, respectively). The absolute and percentage changes in BMD and BMC were decreased in all ROIs in the implanted knee compared with the non-implanted knee, but this did not reach statistical significance. Bone loss was markedly less than reported losses with total knee replacement. There was no significant association with side, although there was a tendency for the BMC to decrease with age in men. The BMC was less in the implanted side relative to the non-implanted side in men compared with women in ROI 2 (p = 0.027), ROI 3 (p = 0.049) and ROI 4 (p = 0.029). The uncemented Oxford medial compartment arthroplasty appears to allow relative preservation of the BMC and BMD of the proximal tibia, suggesting that the implant acts more physiologically than total knee replacement. Peri-prosthetic bone loss is an important factor in assessing long-term implant stability and survival, and the results of this study are encouraging for the long-term outcome of this arthroplasty. Cite this article: Bone Joint J 2013;95-B:1480–3

Aims. This study aimed to identify the effect of anatomical tibial component (ATC) design on load distribution in the periprosthetic tibial bone of Koreans using finite element analysis (FEA). Methods. 3D finite element models of 30 tibiae in Korean women were created. A symmetric tibial component (STC, NexGen LPS-Flex) and an ATC (Persona) were used in surgical simulation. We compared the FEA measurements (von Mises stress and principal strains) around the stem tip and in the medial half of the proximal tibial bone, as well as the distance from the distal stem tip to the shortest anteromedial cortical bone. Correlations between this distance and FEA measurements were then analyzed. Results. The distance from the distal stem tip to the shortest cortical bone showed no statistically significant difference between implants. However, the peak von Mises stress around the distal stem tip was higher with STC than with ATC. In the medial half of the proximal tibial bone: 1) the mean von Mises stress, maximum principal strain, and minimum principal strain were higher with ATC; 2) ATC showed a positive correlation between the distance and mean von Mises stress; 3) ATC showed a negative correlation between the distance and mean minimum principal strain; and 4) STC showed no correlation between the distance and mean measurements. Conclusion. Implant design affects the load distribution on the periprosthetic tibial bone, and ATC can be more advantageous in preventing stress-shielding than STC. However, under certain circumstances with short distances, the advantage of ATC may be offset. Cite this article: Bone Joint Res 2022;11(5):252–259

µCT images are commonly analysed to assess changes in bone density and architecture in preclinical murine models. Several platforms provide automated analysis of bone architecture parameters from volumetric regions of interest (ROI). However, segmentation of the regions of subchondral bone to create the volumetric ROIs remains a manual and time-consuming task. This study aimed to develop and evaluate automated pipelines for trabecular bone architecture analysis of mouse proximal tibia subchondral bone. A segmented dataset involving 62 knees (healthy and arthritic) from 10-week male C57BL/6 mice were used to train a U-Net type architecture, with µCT scans (downsampled) input that output segmentation and bone volume density (BV/TV) of the subchondral trabecular bone. Segmentations were upsampled and used in tandem with the original scans (10µ) as input for architecture analysis along with the thresholded trabecular bone. The analysis considered the manually and U-Net segmented ROIs using two available pipelines: the ITKBoneMorphometry library and CTan (SKYSCAN). The analyses included: bone volume (BV), total volume (TV), BV/TV, trabecular number (TbN), trabecular thickness (TbTh), trabecular separation (TbSp), and bone surface density (BSBV). There was good agreement for bone measures between the manual and U-Net pipelines utilizing ITK (R=0.88-0.98) and CTan (R=0.91-0.98). ITK and CTan showed good agreement for BV, TV, BV/TV, TbTh and BSBV (R=0.9-0.98). However, a limited agreement was seen between TbN (R=0.73) and TbSb (R=0.59) due to methodological differences in how spacing is evaluated. This U-Net/ITK pipeline seamlessly automated both segmentation and quantification of the proximal tibia subchondral bone. This automated pipeline allows the analysis of large volumes of data, and its open-source nature may enable the standardization of stereologic analysis of trabecular bone across different research groups

Aims. Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction. Methods. A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3). Results. No significant differences in RA (p = 0.174) and TS (p = 0.787) were observed. The limb axes were significantly corrected in patients with VVD (p < 0.001). The change in tibial slope (∆TS) did not correlate (r = -0.026; p = 0.885) to the plate’s position on the physis when assessed by lateral radiographs. Conclusion. We were not able to confirm the reported change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD in children without disturbing the knee joint morphology. Cite this article: Bone Joint J 2020;102-B(10):1412–1418

We have performed endoprosthetic replacement after resection of tumours of the proximal tibia on 151 patients over a period of 20 years. During this period limb-salvage surgery was achieved in 88% of patients with tumours of the proximal tibia. Both the implant and the operative technique have been gradually modified in order to reduce complications. An initial rate of infection of 36% has been reduced to 12% by the use of a flap of the medial gastrocnemius, to which the divided patellar tendon is attached. Loosening and breakage of the implant have been further causes of failure. We found that the probability of further surgical procedures being required was 70% at ten years and the risk of amputation, 25%. The development of a new rotating hinge endoprosthesis may lower the incidence of mechanical problems. Limb salvage for tumours of the proximal tibia is fraught with complications, but the good functional outcome in successful cases justifies its continued use

The bone mineral density (BMD) can be measured by dual energy X-ray absorptiometry (DEXA) accurately and precisely. BMD measurements of proximal tibia, where the structure is dominantly trabecular bone, were made on 45 normal women, aged 24–91 (52.0±14.2) years, and on 46 normal men, aged 20–71 (53.7±15.5) years. The precision of BMD measurements of proximal tibia, expressed as the coefficient of variation, was smaller than 4%. Throughout this cross-sectional study, the following results were acquired. The mean BMD in male is higher than that in female. The BMD show a decrease with age at different rates in women and men. The BMD in both genders is found to increase with body weight. A positive correlation is found between the BMD and body height in women, not in men. In right proximal tibia, the BMD of medial regions are higher than that of lateral regions significantly. Our study also demonstrates that the excellent symmetry of the BMD of the bilateral proximal tibias in both genders, but not in men with age less than 50 years old. Through the study of BMD in proximal tibias using the DEXA, it may reflect the bone reactions to many factors, such as age, sex, body weight & height, and weight bearing etc. Such a kind of study might be an useful adjuvant tool to assess the bone remodelling around the knee joint following the different surgical procedures such as total knee arthroplasty or high tibial osteotomy and might predict the future surgical outcomes

Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease and, of the remaining 15, four had above-knee amputations for complications. Infection occurred in seven patients; in five it was related to the lengthening procedure. Aseptic loosening is inevitable in the younger children and only two have avoided a revision, amputation or other major complication; both were aged 12 years at the time of the initial surgery. Despite this, 11 children are alive with a functioning leg and a mean Musculoskeletal Tumour Society functional score of 83%. The lengthening mechanisms used in our series required extensive open operations. We are now using a simpler, minimally invasive, technique which we hope will decrease the incidence of complications. At present, the use of extendible prostheses of the proximal tibia remains an experimental procedure

Introduction. 47 yrs male patient had a prior history. 2005 Fx. proximal tibia (open Fx.). 2007 Metal removal. 2008 Arthroscopic debridement (2 times). He visited out hospital with severe pain and tenderness X-ray (Fig 1) and MRI (Fig 2) findings as follows. Conclusively, He had a chorinic osteomylitis of proximal tibia with soft tissue absess. 1st Surgery. I did arthroscopic debridement Arthroscopic finding shows synovitis, meniscus tear and chondromalacia. I did meticulous debridement (irrigation & curettage). 2nd Surgery. He did primary total knee arthro-plasty instead of two-stage exchange arthroplasty in may, 2010 at the another hospital. 3rd Surgery. After 7 months since he had did total knee arthroplasty, he visited to my hospital again with sudden onset of painful swelling & heating sensation. 4th Surgery. I did second stage reimplantation for infected total Knee arthroplasty after 7 weeks. Now he got a pain relief & ROM restroration. Results. Follow up 12 months X-ray showing all implants to be well-positioned and stable. Clinically, there was no implant considered to be loose. In this study, the knee society and functional scores at final follow up were 82 and 68. Conclusion. The infection after sequales of open proximal tibia fracture is treated by two-stage exchange total knee arthroplasty instead of primary total knee arthroplasty. Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control and improvement in the clinical result 3). We use an antibiotic-loaded cement spacer(ALACS) preserved knee function between stages, resulting in effective treatment of infection, facilitation of reimplantation, and improved patient satisfaction 1). The principle surgical technique used for two-stage revision of infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers 2

Pupose: The purpose of this study was to analyze the outcome of proximal tibia osteoarticular allografts after tumor resections. Material amd Methods: We performed a retrospective study over 58 patients in which a proximal tibia allograft reconstruction was undertaken. All patients were followed for a minimum of 5 years and allografts survival from the date of implantation to the date of revision or the time of the latest follow-up was determined with the use of the Kaplan-Meier method. In all patients, the patellar tendon from the host was reattached by suturing to overlapped donor flaps. Patients were clinically evaluated with the MSTS score system. Results: The global rate of allograft survival was 65% +/− 12% (+/− 2 SE) at five and ten years, with no significant difference between patients who received chemotherapy and those who did not. Allografts needed to be removed in twenty patients due to 12 infection, 4 local recurrences and 4 fractures. Active knee extension was restored in all patients with an average functional score of 26.3 points. Discussion: Survival analysis showed that 65% of proximal tibia osteoarticular allograft reconstructions remain stable at five and ten years. Patellar tendon reconstruction with allogeneic tissue in proximal tibia allograft restores active knee extension with an excellent functional result. Despite the incidence of complications, proximal tibia osteoarticular allografts continue to be a very valuable reconstructive procedure for large defects after resection of bone tumors

Introduction. Precise implant matching with a resected bony surface is a crucial issue to ensure a successful total knee arthroplasty (TKA). Extremely undersized or oversized components should be avoided. Therefore, we should measure the exact anthropometric data of the resected bony surface preoperatively or intraoperatively. The purpose of this study was to intraoperatively analyze the exact anthropometric proximal tibial data of Japanese patients undergoing TKA and correlate these measurements to the dimensions of current prosthetic systems. Patients and Methods. Three hundred and seventy-three knees in 299 Japanese patients were included in this study. There were 246 women and 53 men with a mean age of 74 (range: 63–85) years. All TKAs were performed by 3 senior surgeons (TS, AK, and NM). The bone cut in the proximal tibia was made perpendicular to the longitudinal axis of the tibia in the frontal plane. Intraoperative measurements of the proximal tibial cut surface were taken after proximal tibial preparation. Akagi's line (center of the posterior cruciate ligament tibial insertion to the medial border of the patellar tendon attachment) was adopted as the anteroposterior axis line of the proximal tibia. A mediolateral (ML) line was drawn perpendicular to Akagi's line. Then, anteroposterior (AP), lateral anteroposterior (lAP), and medial anteroposterior (mAP) lines were drawn as shown in Figure 1. Results. There was a significant positive correlation between lAP and ML dimensions. Although there also was a significant positive correlation between lAP and mAP dimensions, individual knees presented much scatter (Figure 2). The lAP dimension was smaller than the mAP dimension in all knees by a mean of 4.5 ± 1.9 mm. The proximal tibia exhibited asymmetry between the lateral and medial plateaus. The recent data of 177 knees indicated that Akagi's line was located 1.0 ± 1.2 mm medial to the AP line. A comparison of the morphologic data and the dimensions of the implants, one of which was a symmetric tibial component (NexGen: Zimmer, Warsaw, Indiana), and the other asymmetric (Genesis II: Smith & Nephew, Memphis, Tennessee), indicated that an asymmetric tibial component could be beneficial in maximizing the coverage of the tibial plateau. However, the size variation of the asymmetric tibial component was poor and the lAP and mAP dimensions showed much scatter; thus, we should measure the proximal tibia and choose the proper tibial component during surgery. Conclusions. This study provides important reference data that may be useful for designing proper tibial components for Japanese patients

Aim. In patients with bone sarcoma, placing mega prostheses in the proximal tibia is associated with high rates of infection. In studies with small numbers of patients and short follow-up periods, silver-coated mega prostheses have been reported to lead to reduced infection rates. To the best of our knowledge, this study is the largest one that has compared the infection rates with titanium versus silver-coated mega prostheses in patients treated for sarcomas in the proximal tibia. Method. The infection rate in 98 patients with sarcoma or giant cell tumour in the proximal tibia who underwent placement of a titanium (n = 42) or silver-coated (n = 56) mega prosthesis. *. was assessed, along with the treatments administered for any infection. Results. As the primary end point of the study, the rates of infection were 16.7% in the titanium group and 8.9% in the silver group, resulting in 5-year prosthesis survival rates of 90% in the silver group and 84% in the titanium group. Overall, seven of 56 patients in the silver group (12.5%) developed periprosthetic infection. Two patients became infected after revision surgery due to mechanical failure of the prosthesis. In the titanium group, one patient developed a periprosthetic infection after revision surgery (which was carried out in 50% of patients) due to a mechanical prosthetic failure, leading to an overall infection rate of 19.0% (eight of 42). Overall, nine of 12 (75%) periprosthetic infections in the two groups occurred within the first 2 years postoperatively, if later revision surgery due to mechanical failure was not necessary. Whereas three of the eight patients in the titanium group (37.5%) ultimately had to undergo amputation due to infected proximal tibia replacement, these mutilating surgical procedures were necessary in the silver group in only one patient (14.3%). In the titanium group, two-stage revision surgery with a temporary antibiotic-impregnated cement spacer was ultimately successful in four of eight patients (50.0%), but this procedure was necessary in only one patient in the silver group (14.3%). Conclusions. The use of silver-coated prostheses reduced the infection rate in a relatively large and homogeneous group of patients. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses

To try to find a solution to the high complication rate associated with harvesting bone graft from the iliac crest, a retrospective and prospective study was undertaken to document bone grafting from the proximal tibia in 37 adult patients undergoing a variety of foot procedures. The hospital charts of 17 patients were evaluated retrospectively for complications (mean follow-up of 27 months), while 20 patients were assessed prospectively by means of a questionnaire (mean follow-up of 7 months). There was an overall complication rate of 10.8%, 5.8% in the retrospective group and 15% in the prospective group. All complications were minor and resolved. Although our overall complication rate is slightly higher than in similar studies, ours is the only prospective study that actively followed the healing of patients’ donor sites. We recommend the proximal tibia as an alternative harvest site. Contrary to popular belief, the proximal tibia provides a large volume of cancellous graft material

The treatment of fractures of the proximal tibia is complex and makes great demands on the implants used. Our study aimed to identify what levels of primary stability could be achieved with various forms of osteosynthesis in the treatment of diaphyseal fractures of the proximal tibia. Pairs of human tibiae were investigated. An unstable fracture was simulated by creating a defect at the metaphyseal-diaphyseal junction. Six implants were tested in a uniaxial testing device (Instron) using the quasi-static and displacement-controlled modes and the force-displacement curve was recorded. The movements of each fragment and of the implant were recorded video-optically (MacReflex, Qualysis). Axial deviations were evaluated at 300 N. The results show that the nailing systems tolerated the highest forces. The lowest axial deviations in varus and valgus were also found for the nailing systems; the highest axial deviations were recorded for the buttress plate and the less invasive stabilising system (LISS). In terms of rotational displacement the LISS was better than the buttress plate. In summary, it was found that higher loads were better tolerated by centrally placed load carriers than by eccentrically placed ones. In the case of the latter, it appears advantageous to use additive procedures for medial buttressing in the early phase

The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia. We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months

Above-knee amputation has been the traditional treatment for osteosarcoma of the proximal tibia. Recent advances in chemotherapy have encouraged the development of limb-salvage techniques. Van Nes rotationplasty for malignant lesions of the distal femur has increased in popularity as a reconstructive technique, but no similar procedure has been described for lesions of the proximal tibia. We have developed a modified rotationplasty for this lesion and have performed it in four children. The surgical technique, postoperative management and results of the procedure are described. Two patients had delayed wound healing. No other complications have developed and our patients were disease-free at follow-up, while the appearance of the leg was well accepted by the patients and their parents. This procedure is a useful addition to the armamentarium of the tumour surgeon for the treatment of malignant lesions of the proximal tibia

Introduction: The use of allograft prosthetic composite (APC) of the proximal tibia offers advantages over prosthetic replacement or osteoarticular graft with a better functional outcome since the possibility of a careful soft tissue reconstruction;. Materials and Methods: From 1994 to 2002, 62 APC of the proximal tibia were performed in our department after bone tumor resection (56 malignant bone tumors, 4 cases of previously failed knee implant and 2 stage 3 benign tumors). The patients median age was 18 yrs (range: 11–77 yrs) and the mean resected length was 13.2 cm (range: 8.5–28 cm). The median follow up was 59 months (range: 13–137 months). Results: In three patients (4,8%) a recurrence was reported at 22, 33 an 40 months and amputation was performed. Infection was reported in 15 patients (24.2%): 2 early infections (healed with surgical debridment), 1 femoral stem septic loosening (treated with early revision with cemented stem); in 8 cases removal of the infected APC was required followed by implant of a new prosthetic device after cement spacer; two infections did not healed and patient underwent amputation; in two cases a good functional result was achieved removing the infected graft and covering the proximal tibia with cement and no other surgery was required. Non union of the graft was observed in 8 patients (12.9%): in 4 patients autologous bone grafting was necessary to heal the osteotomy line. In other 3 cases non union was associated with graft fracture. In one case non union was associated with tibial stem loosening and revision of the whole implant was done. Polyethylene wear was assessed in 5 patients (8%) and revision of the polyethylene components was always required. Nine patellar tendon rupture (14.5%) were assessed and repaired was performed in seven cases. The functional outcome of 42 patients with more than two years of follow up was excellent in 25 cases, good in 13, fair in 2 and poor in 2. Discussion: APC of the proximal tibia is an effective alternative to osteoarticular graft and modular prosthesis because it allows good to excellent results in most of the patients (90.4%). The major concern is infection rate (24.2%) that usually lead to amputation (80%). Non union does not usually represent a problem because it’s tendency to spontaneous or bone grafting induced healing. Aseptic loosening of the tibial or femoral stem is rare. Patellar tendon rupture rate (14.5%) is similar to modular prosthetis rate and can be lowered using a femoral component with patellar groove

Since the introduction of carving skis, the injuries of the tibia is changing from simple fractures of the diaphyse to complex fractures of the epiphyses, according to high energy traumas. There are no studies about results of the treatment and consequences after winter sport accidents. Method: Prospective documentation of all proximal tibia fractures after winter sport accidents, which were treated between 01.12.2006 and 31.04.2009 in the Trauma Department of the Klinikum Garmisch-Parten-kirchen, Germany. X-Rays and CT scans were classified according to the AO –Classification. Operations, complications, co-injuries and the hospital stay were analysed. We performed the Lysholm score, WOMAC Knee-score and the Tegner-index on the day of injury, 6 months, 12 months, and 2 years after injury. Results: 78 patients had a proximal tibia fracture following a skiing accident, 36 Male and 42 female. All except two patients had a monotrauma of the proximal tibia. Mean age 46 ± 15 years. 17 types A.1.3, 41 types B and 18 types C3 fractures. 4 patients developed a compartment syndrome, one patient had a lesion of the n. peroneus. 65 patients were operated in our hospital. In 8 patients we performed a conservative treatment. The mean hospital stay was 12 ± 7.5 days. In 15 patients a menisci reconstruction was necessary. 6 patients had a postoperative complication: 3 thromboses, 2 cardiac decompensations, 1 wound healing problems. By now 42 patients were ready for follow-up. So far the mean follow-up time is 13.8 months. The Lysholm score was at 12 months (n= 22) 78 ± 20 points. The Tegner score was pre-injury 6.2 ± 1.1 and 12 months post-injury 4.1 ± 1,8. The results of the WOMAC score show an improvement in the subcategories pain and function in all patients. In the subcategory stiffness only the type A and B fractures show an improvement during the follow-up. Conclusion: The proximal tibia joint fractures are a serious injury. The most patients’ activity level is tremendously reduced. The major problem after one year seems to be the ligament instability of the knee. A beginning knee arthritis after one year becomes relevant only in the type C fractures. More effort for the prevention of the proximal tibia fractures while skiing is necessary

Modular endoprostheses are commonly used for reconstruction of proximal tibia defects after bone tumor resection and patellar tendon reattachment directly on the prosthesis represent an issue frequently ending in extension lag. Allograft-prosthesis composite implants theoretically provide the advantages of prosthetic implants (joint stability, mechanical resistance and long term durability) and the advantages of massive allograft reconstruction (bone stock mantainance and biologic reattachment of patellar tendon). From 1997 to 2007 19 patients (mean age: 39±16 years old) underwent proximal tibia oncologic intra-articular resection with wide margins. Primary diagnosis included giant cell tumor, osteosarcoma, chondrosarcoma and a failed osteoarticular allograft in 10, 4, 3 and 2 patients respectively. Tibial resection length was 10.4±3.4 cm in 18 knees. In one patient with chondrosarcoma the entire tibia was resected. Three patients received preoperative and postoperative chemotherapy, one only postoperative. Reconstruction was performed with an allograft-prosthesis composite implant and direct suture of the host patellar tendon to the allograft one. Fresh frozen allograft and modular Link prosthesis were used for reconstruction. Five to six weeks of knee immobilization in extension followed the operation. A transient peroneal nerve palsy was observed in three patients. Two patients with a stiff knee underwent an open release after less than one year from index surgery. One patient had a local recurrence from osteosarcoma and underwent an above knee amputation. No patient developed distant metastasis at follow-up. After 59±37 months none of the patients had implant revision for mechanical complications. One patient had 2-stage implant revision for deep infection. A minor allograft resorption with aseptic drain was observed in one patient who underwent surgical debridement. One other patient had a moderate allograft resorption. Knee flexion was 96±12 degrees. All the patients but two could reach complete knee extension and only two had a minor extensor lag (less than 15 degrees). In conclusion intrarticular tibia resection and allograft-prosthesis composite replacement ensures satisfactory oncologic and functional results at a mid-term follow-up

As for the number of patients who requires total knee arthroplasty (TKA), Asian-Pacific countries will be the most important market. However, due to the paucity of anthropometric data on the proximal tibia in this population, many prostheses designed for Caucasian knees have been introduced without specific modification.The aim of the current study was to analyze the geometry of the proximal tibia to design the optimum component for the Japanese population. Anthropometric data on the proximal tibia of 100 knees in 80 patients undergoing TKA was obtained. Briefly, anterior-posterior (AP) and medial-lateral (ML) lengths were measured with a combination of two different methods, namely on the computed tomography (CT) images obtained preoperatively and intraoperative direct measurement on tibial resection surface. Reproducible measurement was possible only when the intraoperative measurement was combined with the corresponding CT images while the direction of measurements being aligned to the epicondylar axis of the femur. It was shown that smaller components with an ML of around 60 mm were rarely required. Tibial component size variation should focus on an ML length of 65 to 75 mm because 76 of 100 knees (76 %) fell into this size range. When the subjects were confined to women, 70 of 77 knees (91%) were included in this size range. The intraoperative AP to ML ratio had a negative correlation with the ML length (r = −0.412, P < 0.0001) indicating that bigger knees were shallower in the AP direction. The size variation of currently popular pros-theses were not in accordance with the geometry of the tibial resection surface shown in this study. The results of this study applied to a cross-section of the Japanese population can be used by manufacturers to create a prosthesis suitable for most of the Asian-Pacific population