Comparing Tibial Osteotomy and Patellar Osteotomy to Pedicle Freezing in Proximal Tibial Malignant Bone Tumors: A Case Series Study

BACKGROUND AND OBJECTIVES: Pedicle freezing with liquid nitrogen is a biological reconstruction method used for aggressive proximal tibial tumors. This study compared outcomes between tibial and patellar osteotomy approaches. METHODS: This retrospective study included 14 patients with malignant bone tumors who underwent pedicle freezing between January 2021 and March 2024. Ten patients underwent tibial osteotomy; four underwent patellar osteotomy. Surgical differences, postoperative complications, bone union, functional recovery, and oncological outcomes were analyzed. RESULTS: Tibial osteotomy required more plating, causing a greater increase in tibial diameter. Flap reconstruction was needed in six (60%) and two (50%) patients in the tibial osteotomy group and patellar osteotomy group, respectively. The bone nonunion rates were similar; median union times were 10.5 and 8.5 months. Wound complications occurred exclusively in the tibial osteotomy group (four patients), all regarding difficulties in wound closure and flap reconstruction. Tibial osteotomy resulted in more implant-related complications, whereas knee range of motion and Musculoskeletal Tumor Society scores were comparable. Tumor recurrence occurred in three cases (two tibial, one patellar), with two patients having preexisting metastases. CONCLUSIONS: Both techniques were feasible with comparable union and functional outcomes. Tibial osteotomy often requires additional plating and has more wound complications. Given the preliminary nature and limited sample size of this study, further research is required.