Introduction Reconstruction of the proximal part of the tibia in children with use of an unconstrained tibial component cemented in an allograft-prosthetic composite after proximal tibial resection spares the distal femoral physis and articular cartilage, maintains the bone stock of the tibia, and allows the allograft to be adapted to the small tibial dimension in very young patients.
Step 1: Make the Incision Make a longitudinal incision medially or laterally, depending on the side of the biopsy (usually medial), encompassing and encircling the biopsy site.
Step 2: Perform the Arthrotomy A parapatellar arthrotomy is performed, and the cruciate ligaments are cut close to the femoral attachment.
Step 3: Isolate the Vascular Bundle Retract the medial gastrocnemius muscle and then isolate and protect the popliteal and posterior tibial vessels.
Step 4: Perform an Osteotomy of the Tibia Perform an osteotomy of the tibiofibular joint and the tibial shaft at the appropriate level as determined on the basis of the preoperative imaging, and then complete the resection.
Step 5: Prepare the Allograft on a Separate Table Cut and prepare the allograft according to the specimen dimensions.
Step 6: Prepare the Composite Device Cement the tibial component of an unconstrained total knee prosthesis in the allograft and place the trial device.
Step 7: Fix the Composite Device and Suture the Capsule and Ligaments Place the trial composite device and then fix the composite device to the host tibia and suture the capsule and ligaments.
Step 8: Postoperative Care Immobilize the knee with an above-the-knee plaster cast, which is worn for six weeks, and then have the patient perform progressive functional rehabilitation.
Results The rate of postoperative infection after proximal tibial reconstruction with a resurfaced allograft composite in children has been found to be no higher than that with other reconstructive techniques for the …
Enter your JBJS login information below.