Characterization and Surgical Management of Metastatic Disease of the Tibia

Osseous metastases are common in advanced cancer stages. The tibia is the appendicular skeleton bone affected third most often. However, tibial metastases are not well described. We conducted a retrospective descriptive single-institution study of patients with evidence of tibial metastatic disease in order to better characterize tibial metastases in their anatomical distribution and histology, and to describe their clinical presentation and surgical management. Using proprietary research software, we searched pathology and radiology reports and cross-referenced results with Current Procedural Terminology procedure codes to identify patients with metastatic lesions of the tibia. We then reviewed these patients' medical records and reviewed and verified all available imaging. We reviewed the medical records of 36 patients (20 females, 16 males) with 43 affected tibiae. Mean age was 63.5 years. Of 12 different primary neoplasms, the most common were prostate, breast, and lung cancers. The proximal tibia was the region most commonly affected, followed by the diaphysis. Of 6 impending fractures, 3 were treated with intramedullary nail, 2 with total knee megaprosthesis, and 1 with total knee arthroplasty. Of 2 pathologic fractures, 1 was treated with intramedullary nail and 1 with periarticular locking plate. Almost all identified patients (88.9%) had other metastatic lesions. Almost half (47.2%) of patients presented with symptomatic tibia lesions. Mean time from diagnosis of malignancy to tibial metastasis was 1282 days (range, 0-3708 days). Metastases to the tibia are uncommon but often require surgical intervention. Fixation technique should be selected on a case-by-case basis, and patients should be treated by a multidisciplinary team. Patients with known malignancy and tibial pain should undergo a work-up for tibia lesions.