RESUMO
The concept of limb-sparing surgery, or limb salvage, has gradually evolved over the past 25 years. Prior to this the basic principles of surgical oncology for the extremities consisted solely of determining the correct level at which to perform an amputation. Extremity amputation with wide or radical surgical margins was the primary treatment for bone and soft tissue malignancies involving the extremities until the 1970s. Advances in adjuvant treatments modalities, including chemotherapy and radiotherapy have improved survival and increased the role of limb salvage surgery. In addition, it has been shown that local control with limb salvage does not adversely affect the progression of the systemic disease. The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of tumor around the knee joint is a major progress that provides an immediate mobile joint after surgery. Twenty patients were included in this work. According to the staging system of Enneking et al., they were classified into 6 patients with an aggressive benign giant cell tumor [30%] and 14 patients with primary malignant bone tumors [70%]. These tumors were all located around the knee, 8 at proximal tibia [40%] and 12 at the distal femur [60%]. The six benign lesions were recurrent giant cell tumor after a pervious operative curettage and autogenous bone grafting or packing with bone cement in 4 of them [20%] and 2 [10%] were aggressive giant cell tumor grade 3 from the start. The 14 patients with primary malignant bony lesions, 3 of them were grade 1B and 11 were grade 11B. Wide resection was achieved followed by reconstruction by modular replacement endoprosthetic system. The follow up time was between 30 - 60 months with a mean of 46.3 months. The functional results of the procedure were rated as good to excellent with a mean of 83.3%. The end results of the procedure are justifiable for tumor surgery provides mobile knee joint with a stable limb and excellent functional end result. Complications occurred in 5 patients [25%] 4 of them necessitate reoperation. The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of tumor around the knee joint is a major progress that provided an immediate mobile joint after surgery. It has also obviated the need for prolonged immobilization in cast as with cases of biological reconstruction. This concept is important in such patients with short life expectancy but it is not free of complications and may need multiple surgeries