Figure 2

Surgical management of periendoprosthetic tibial chondrosarcoma. A medial parapatellar approach was used for exposition, while the patellar-ligament was cut proximally, because of macroscopic suspected tumor infiltration (a). Medial subcutaneous preparation was performed carefully and pes-anserinus muscle insertions were secured for later reattachment (a). After the tibia was exposed 15 cm from joint line, tibial resection was performed as planned and detachment from the popliteal neurovascular structures was performed carefully, allowing en-bloc tumor resection. Because of suspicious marrow tissue a second tibial resection was performed 5 cm more distally (b), which resulted in R0 resection status. The femoral cut was performed as planned at 8 cm proximal to the joint line, to include the femoral component and match the planned femoral component of the revision implant (c). After marrow preparations and trialing, reconstruction of the extensor mechanism was prepared by creating a suprapatellar tunnel in the quadriceps tendon and implantation of an alloplastic ligament (d). Original components were cemented, using the prior tested sizes. Pes-anserinus and biceps-femoris tendons were reattached at the correspondent implant sites (e). The alloplastic ligament was secured with the screw-mechanism of the tibial implant and additional sutures (f). Drains were implanted distant to the tumor location and tension-free wound closure was performed (f).