Limb-Sparing Surgery of the Proximal Tibia

It is a procedure that involves removing a tumor, usually malignant or benign aggressive, of the proximal tibia (upper part of your shin bone near knee joint) and in most instances replacing the bone and knee joint with a special customizable proximal tibia tumor prosthesis.

Proximal Tibial Prosethesis

What is a Limb-Sparing Surgery of the Tibia/Knee?

The knee joint consists of your distal femur (lower part of thigh bone), tibia (shin bone), fibula, and patella. The proximal tibia (upper part of shin bone) is a relatively common site for primary bone sarcomas, metastatic disease, and aggressive benign tumors. The common muscles of this area include the gastrocnemius, soleus, and popliteus (calf muscles). Some of the tumors arising in this region include osteosarcomas, ewing’s sarcoma, and giant cell tumor.  Limb-sparing surgery can be performed for approximately 95% of tumors arising from the proximal (upper) tibia. In some instances the extremity cannot be saved and a above the knee amputation is performed. 

Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, invasion of the pelvis, extensive disease, contamination from a poorly performed biopsy, recurrent disease.


What’s involved in the technique?

What you can expect afterwards

After your surgery you will spend a few nights in the hospital and then will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Patients are usually kept in a knee brace with the knee fully extended for 6 weeks to allow tendon and muscle to heal down to the prosthesis. This is important for the ultimate function of the prosthesis as the biggest difficulty after this surgery is extending the knee completely. After 6 weeks, the muscle and tendon should be healed down to the prosthesis sufficiently to start controlled knee flexion in the brace. You will then proceed to flex the knee 10-20 degrees per week in the brace. You will be advanced 10-20 degrees per week provided you can get your knee straight on your own in the brace. In addition, once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.  

You will be monitored periodically with X-ray and MRI imaging over the course of 5 years to ensure there are no signs of recurrence. You will have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the integrity of the limb has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy.

Types Of Physical Therapy

Proximal Tibia Prosthetic Replacement Video

Dr. James Wittig narrates a video illustrating the surgical technique for resection of a proximal tibia tumor and reconstruction using a proximal tibia tumor prosthesis. | WATCH VIDEO