Reconstruction of soft tissues and preservation of the extensor mechanism integrity provide a major challenge following resection of the proximal tibia tumours. We propose a novel surgical technique for neopatellar ligament reconstruction using hamstring tendon in proximal tibia tumour cases. This study details the surgical technique, early clinical and radiological outcomes, and the potential long-term benefits of this innovative reconstructive approach following proximal tibia megaprosthesis implantation. This study included 15 patients with proximal tibia tumours treated at orthopaedic oncology unit in Gujarat Cancer and Research Institue (GCRI), Ahmedabad, India. Surgical procedures included resecting the proximal tibia tumour, implanting a megaprosthesis, and using hamstring tendons to reconstruct the extensor mechanism by the neopatellar ligament. Autologous hamstring tendons (gracilis and semitendinosus) harvested from the ipsilateral leg were used and these tendons were braided together with a nonabsorbable suture and threaded through the remaining patellar tendon. The braided tendons were then secured to the holes in the tibial tuberosity of the proximal tibia megaprosthesis implant XLO (Ortho Life Systems, India) using nonabsorbable fibre wire sutures FiberWire (Arthrex, USA). The tension in the tendons was optimized and the sutures were tightened with the knee in full extension and the implant with neopatellar ligament were covered by medial gastrocnemius muscle flap. The mean follow-up period was 19 months (13 to 24), the mean age of the study group was 24.6 years (14 to 44), and it included 11 males and four females.Aims
Methods
There is currently no consensus about the mean
volume of blood lost during spinal tumour surgery and surgery for metastatic
spinal disease. We conducted a systematic review of papers published
in the English language between 31 January 1992 and 31 January 2012.
Only papers that clearly presented blood loss data in spinal surgery
for metastatic disease were included. The random effects model was
used to obtain the pooled estimate of mean blood loss. We selected 18 papers, including six case series, ten retrospective
reviews and two prospective studies. Altogether, there were 760
patients who had undergone spinal tumour surgery and surgery for
metastatic spinal disease. The pooled estimate of peri-operative
blood loss was 2180 ml (95% confidence interval 1805 to 2554) with catastrophic
blood loss as high as 5000 ml, which is rare. Aside from two studies
that reported large amounts of mean blood loss (>
5500 ml), the
resulting funnel plot suggested an absence of publication bias.
This was confirmed by Egger’s test, which did not show any small-study
effects
(p = 0.119). However, there was strong evidence of heterogeneity
between studies (I2 = 90%; p <
0.001). Spinal surgery for metastatic disease is associated with significant
blood loss and the possibility of catastrophic blood loss. There
is a need to establish standardised methods of calculating and reporting
this blood loss. Analysis should include assessment by area of the
spine, primary pathology and nature of surgery so that the amount
of blood loss can be predicted. Consideration should be given to
autotransfusion in these patients. Cite this article:
