The Journal of Arthroplasty
Volume 23, Issue 2 , Pages 254-262, February 2008

The Anterior Popliteal Approach for Popliteal Exploration, Distal Femoral Resection, and Endoprosthetic Reconstruction

  • Chia-Chun Wu, MD

      Affiliations

    • Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
    • ,
  • Tamir Pritsch, MD

      Affiliations

    • Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, District of Columbia
    • Corresponding Author InformationReprint requests: Tamir Pritsch, MD, Orthopedic Oncology, C2173, Washington Cancer Institute, 110 Irving St NW, Washington, DC 20010.
    • ,
  • Ahmad Shehadeh, MD

      Affiliations

    • Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, District of Columbia
    • ,
  • Jacob Bickels, MD

      Affiliations

    • The National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, Israel
    • ,
  • Martin M. Malawer, MD

      Affiliations

    • Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, District of Columbia
    • Department of Orthopedics, Georgetown University, Washington, District of Columbia
    • Pediatric and Surgery Branch, National Cancer Institute, Bethesda, Maryland

Received 10 May 2006; accepted 3 January 2007. published online 07 February 2007.

Abstract 

Distal femoral resection and endoprosthetic reconstruction are sometimes associated with flap necrosis and inadequate soft tissue coverage. We evaluated the anterior popliteal surgical approach, which was designed to reduce those complications by using a posteromedial myocutaneous flap based upon the vastus medialis. A retrospective analysis of 46 consecutive patients was performed, and results were compared with historical controls. Compared with 19.4% with wound complications and 22.7% with gastrocnemius flap transfers in previous series by the senior author, 7.8% of patients in the present study had minimal superficial flap necrosis, and no gastrocnemius transfers for soft tissue coverage were required. The median Musculoskeletal Tumor Society score was 26, and the local recurrence rate 2 years or more after resection of osteosarcoma was 4%. The anterior popliteal approach to the distal femur limited wound complications and provided good soft tissue coverage of the endoprostheses.

Key words: distal femoral resection, surgical approach, endoprosthesis, anterior popliteal approach, myocutaneous flap, vastus medialis

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 No benefits or funds were received in support of the study.

 Investigation performed at the Department of Orthopedic Oncology, Washington Cancer Institute, Washington Hospital Center, Washington DC.

PII: S0883-5403(07)00044-7

doi:10.1016/j.arth.2007.01.005

The Journal of Arthroplasty
Volume 23, Issue 2 , Pages 254-262, February 2008

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