Palliative Surgical Management of a Metastatic Lesion of the Tibia with Extension into the Popliteal Fossa Using Polytetrafluoroethylene Felt and Bone Cement

Abstract

The treatment of metastatic bony lesions with the involvement of adjacent neurovascular structures presents a surgical challenge. We present—to the best of our knowledge—the first case of a patient suffering from a metastatic lytic lesion at the proximal tibia who underwent palliative treatment with the use of a polytetrafluoroethylene (PTFE) felt as a liner in order to preserve the adjacent vasculature and nerves. An 82-year-old female patient was diagnosed with multiple lytic bone metastases from renal cell carcinoma. One of these metastatic lesions was located at the proximal metaphysis of the left tibia. The lesion destructed the proximal metaphyseal part and the posterior cortex, and it was extending into the popliteal fossa. As a result, the patient was unable to bear weight. The patient was not fit to undergo radical operative treatment. As a means of palliative therapy, she underwent intralesional curettage and instillation of Poly-Methyl-Methacrylate (PMMA) bone cement using an alternative novel surgical technique with the use of a PTFE felt as a liner in order to protect the adjacent vasculature and nerves. This technique has proven to be successful in preventing cement leak into the popliteal cavity and efficient in allowing the patient to bear weight and walk independently until she demised 14 months later. The use of a PTFE felt as a liner, when treating lytic lesions, in order to protect the adjacent vasculature and nerves from PMMA leakage, is a helpful novel surgical option in cases when a radical treatment cannot be implemented.