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Purpose <p>There are numerous reconstruction techniques available for the removal of malignant tumors in the distal tibia. Various reconstruction techniques result in different MSTS functional scores and complications. Therefore, controversies regarding the best reconstructive options after limb salvage for malignant tumor of the distal tibia continues. This study aims to evaluate the outcomes of limb salvage procedures utilizing 3D-printed ankle joint arthrodesis prostheses in patients who diagnosed with distal tibia malignant tumors and declined below knee amputation.</p> Methods <p>We retrospectively reviewed 7 patients with distal tibia malignant tumor treated from 2020 to 2023. Each patient underwent limb salvage surgery with a 3D-printed prosthesis while preserving the subtalar joint, alongside pre- and post-operative chemotherapy. We used the Enneking and Musculoskeletal Tumor Society (MSTS) systems to stage our patients. We assessed survival, local recurrence, MSTS function and complications.</p> Results <p>The mean age of the patients was 20.7&#xa0;years (8 to 49) and the mean follow-up was 35.4&#xa0;months (18 to 58). The average resection length of the tibia was 11.7&#xa0;cm (6.5 to 18). All patients were Enneking IIB. A wide margin excision was acheived in one, marginal in six. Skeletal reconstruction was performed using 3D-printed ankle joint arthrodesis prosthesis. There were no complications with deep infection, delayed wound healing or necrosis of the wound except for two cases that developed prosthetic loosening and subsequent subsidence at 12&#xa0;months postoperatively. The average MSTS scores in six months after the operation was 26.7/30, with no reported cases of local recurrence or distant metastases.</p> Conclusion <p>For distal tibial malignant bone tumors, limb salvage is possible with a 3D-printed ankle joint arthrodesis prosthesis and preservation of the subtalar joint in carefully chosen patients. This is a safe and efficient treatment approach.</p> Level of evidence <p>IV, therapeutic study.</p>

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Limb salvage for malignant bone tumors of distal tibia with 3D-printed ankle joint arthrodesis prosthesis and preserving subtalar joint

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月28日

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  • Xiaojun Zhu,
  • Jinxin Hu,
  • Anqi Wang,
  • Guohui Song,
  • Chuangzhong Deng,
  • Jinchang Lu,
  • Qinglian Tang,
  • Jin Wang

摘要

Purpose

There are numerous reconstruction techniques available for the removal of malignant tumors in the distal tibia. Various reconstruction techniques result in different MSTS functional scores and complications. Therefore, controversies regarding the best reconstructive options after limb salvage for malignant tumor of the distal tibia continues. This study aims to evaluate the outcomes of limb salvage procedures utilizing 3D-printed ankle joint arthrodesis prostheses in patients who diagnosed with distal tibia malignant tumors and declined below knee amputation.

Methods

We retrospectively reviewed 7 patients with distal tibia malignant tumor treated from 2020 to 2023. Each patient underwent limb salvage surgery with a 3D-printed prosthesis while preserving the subtalar joint, alongside pre- and post-operative chemotherapy. We used the Enneking and Musculoskeletal Tumor Society (MSTS) systems to stage our patients. We assessed survival, local recurrence, MSTS function and complications.

Results

The mean age of the patients was 20.7 years (8 to 49) and the mean follow-up was 35.4 months (18 to 58). The average resection length of the tibia was 11.7 cm (6.5 to 18). All patients were Enneking IIB. A wide margin excision was acheived in one, marginal in six. Skeletal reconstruction was performed using 3D-printed ankle joint arthrodesis prosthesis. There were no complications with deep infection, delayed wound healing or necrosis of the wound except for two cases that developed prosthetic loosening and subsequent subsidence at 12 months postoperatively. The average MSTS scores in six months after the operation was 26.7/30, with no reported cases of local recurrence or distant metastases.

Conclusion

For distal tibial malignant bone tumors, limb salvage is possible with a 3D-printed ankle joint arthrodesis prosthesis and preservation of the subtalar joint in carefully chosen patients. This is a safe and efficient treatment approach.

Level of evidence

IV, therapeutic study.