Resection arthrodesis for giant cell tumors around the knee (original) (raw)
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Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee
SICOT-J
Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 pat...
Resection arthrodesis for the management of aggressive giant cell tumor of the distal femur
Indian journal of …, 2009
Background:Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent, and extensive tumors. Wide resection and mobile joint reconstruction are preferable for treating tumors around the knee. In certain situations, resection arthrodesis or an amputation is suggested. In this prospective study we report the outcome of 8 patients of aggressive GCT of lower end of femur treated with resection arthrodesis.Materials and Methods:Eight patients with mean age of 37.25 years (range 30–45 years) with Campanacci Grade III (Enneking stage III) giant cell tumors at the distal femur were treated with wide resection and arthrodesis using dual free fibular graft and locked intramedullary nail from January 2003 to January 2008. There were four males and four females patients. The mean follow-up was 48.75 months (range 30–60 months). The functional evaluation was done using the standard system of musculoskeletal tumor society with its modification developed by Enneking et al.Results:At the final follow up the functional score ranged from 20 to 27 out of total score of 30. Graft union was achieved in all cases in a duration mean of 14.5 months (range 12-20 months).One case required secondary bone graft due to delayed union, and one case had superficial wound infection which healed on systemic antibiotics. At final followup, all the patients were disease free.Conclusion:Wide resection and arthrodesis in aggressive GCTs of the distal femur with involvement of all muscle compartments is a good treatment option. Resection arthrodesis offers a biological reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.
A Tertiary Care Centre Experience of Recurrent Giant Cell Tumor Around the Knee Joint
Cureus
Introduction: Giant cell tumor (GCT) is a benign but locally aggressive bone tumor. It has a peak incidence between 30-40 years with a predilection for the epiphyseal/metaphyseal region of bone. The most common locations for bone GCT are the distal femur, proximal tibia, distal radius, and sacrum in decreasing order. Material and Methods: In this retrospective study, 22 patients (13 females and nine males) with recurrent giant cell tumors around the knee joint between 2009-2022, with a mean age of 30.2 years (range: 18-55) were included. The patients were followed up monthly for three months, three-monthly for the next two years, six-monthly for the next five years, and thereafter, yearly. The mean follow-up period was 36.97 months (range 23-120 months). Results: There were 19 recurrences after curettages and three after resections. Re-extended curettage was done in 17 cases and the resultant cavities were filled with autologous bone grafts in six and with polymethyl methacrylate (PMMA) cement in the other 11 cases. Reconstruction with megaprosthesis was done in two patients whereas knee arthrodesis was done in two patients after wide resection. The average Musculoskeletal Tumor Society (MSTS) score of our series of 22 patients was 23.1 (Range: 19-30). Conclusion: Campanacci grade 1 and 2 lesions can be successfully treated with extended curettage and bone grafting/bone cementing. For patients with grade 3 lesions, there are two options available according to the financial status of the patient; the first option is reconstruction with prosthesis and the other option is arthrodesis.
Cureus, 2021
Giant cell tumors (GCTs) are primary bone tumors that occur most commonly in long bones, with half such tumors occurring in the distal femur, proximal tibia, and fibula. Around 12% of patients present with a pathological fracture indicating more aggressive disease. Arthrodesis after tumor resection is a popular choice due to its affordability and early postoperative mobilization, as well as low risks of implant loosening, infections, malignant lesions, or mortality. A free fibular graft is a popular option in limb-sparing surgery for long bone tumors. A bone graft and nail can be used to reconstruct long bones and bridge defects up to 25 cm. In developing countries, the cost of the imported mega prosthesis, around 8,500 US$, means many patients cannot afford the treatment. We describe a case of a GCT of the distal femur treated by excision of the tumor and reconstruction using a fibular bone graft, with knee arthrodesis using a custom-made long intramedullary interlocking nail fixation across the femur to the knee and the tibia. The length was achieved with 1 cm shortening post-surgery. The result was satisfactory, and partial weight-bearing was allowed three months after the surgery. At the one-year follow-up, there was no recurrence, and the patient had the full weight-bearing ability.
Giant Cell Tumors (GCT) Around Knee- Curettage and Reconstruction by Ilizarov Technique
MOJ Orthopedics & Rheumatology, 2015
Purpose: To evaluate outcomes of 17 patients who underwent curettage, use of phenol and reconstruction using the llizarov technique for giant cell tumors (GCT) of bone around the knee. Methods: 12 men and 5 women aged 18 to 45 (mean 26) years underwent intralesional curettage, use of phenol, and reconstruction using the Ilizarov technique for GCT of the proximal tibia (n=14) or distal femur (n=3), 5 of the cases were recurrence. 3, 12 and 2 tumors were classified as grade-I, grade-II and grade-Ill, respectively. One of the grade-III tumors was associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol and reconstruction by Ilizarov technique. 1,2 Functional outcome was evaluated using the Musculo skeletal tumor society (MSTS) score. Results: The mean follow up period was 6 (2.5-10) years. The mean MSTS score was 28.5 out of 15 (Standard deviation, 3; range, 15-30. No patient had malignant transformation. Conclusion: Intralesional curettage use of phenol and reconstruction with llizarov for GCT of bone achieved good functional outcome and no recurrence rate.
Giant cell tumor locally advanced around the knee: treatment and literature review
Revista Brasileira de Ortopedia (English Edition), 2017
Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics. They are more prevalent in the third decade of life and demonstrate a preference for locating in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. The risk of lung metastases is around 3%. Between October 2010 and August 2014, nine patients diagnosed with locally advanced GCT or with pathological fracture to the knee level underwent surgical treatment. The aim of this study was to evaluate the results of the treatment, particularly with regard to relapse, and to conduct a literature review. There was a predominance of males (77.7%). The most common location was the distal femur. Four patients (44%) developed local recurrence in the first year after surgery, three in distal femur and one in proximal tibia. Of the two patients with pathologic fracture at diagnosis, one of them presented recurrence after five months. The treatment of GCT is still a challenge. The authors believe that the best treatment method is wide resection and reconstruction of bone defects with non-conventional endoprostheses. Patients should be aware and well informed about the possible complications and functional losses that may occur as a result of the surgical treatment chosen and the need for further surgery in the medium and long term.
International Surgery Journal
Background: Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. The aim of the study was to determine the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed.Methods: Between January 2017 and March 2021, 14 patients in the age group of 28-48 years (mean=42.85 years) with Campanacci stage three giant cell tumors around the knee were studied (12-distal femur patients, 2-proximal tibia). Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb. Results: All the patients were followed up for 12-44 months (mean=29.5 months), the average knee flexion at 6 m...
Functional Outcome of Extended Curettage and Reconstruction for Giant Cell Tumor around Knee
2021
Background: GCT Bone is the commonest benign bone tumor with female predominance and commonly seen around knee joint. Treatment of GCT can be done by curettage with reconstruction or wide resection. The aim of this study is to see functional outcome of extended curettage and reconstruction with bone cement or sandwich technique along with internal fixation. Method: A total of 9 females and 6 males aged between 20-50 years managed with extended curettage and reconstruction with bone cement(6) or sandwich technique(9). Along with internal fixation in all patients except two patients (small lesion less than 5cm) between January 2015 to December 2020 were taken. Extended curettage was done with the help of 5% phenol and high speed burr. Functional outcome was evaluated using Musculoskeletal tumor society score (MSTS). Results: The mean follow up period was 20.13 months (range 12-48 months). The mean MSTS score at final follow up was 25.27 out of 30. Age, sex did not have much effect on ...
Joint Preservation after Extensive Curettage of Knee Giant Cell Tumors
Clinical Orthopaedics and Related Research®, 2009
Curettage is the most attractive procedure for surgically treating a giant cell tumor because it preserves joint function. However, since many giant cell tumors compromise subchondral bone this technique can jeopardize the articular surface with subsequent fractures or collapse. We asked whether intralesional curettage of a giant cell tumor close to the knee that combined morselized bone and cortical structural allograft would preserve joint function. We retrospectively reviewed 22 patients treated with that approach. The minimum followup was 2 years (average, 48 months; range, 24-80 months). The distal femur was involved in 12 patients and proximal tibia in 10. Complications and failures were recorded and functional results evaluated with Musculoskeletal Tumor Society score. We determined survivorship using the Kaplan-Meier technique using removal of the implant as the endpoint. The survival was 85% and the average functional score 28 points.
Management of Campanacci type III giant cell tumor
International Journal of Orthopaedics Sciences, 2017
Giant cell tumor is an aggressive benign tumor of the bone, involving long bone. They are commonly present around knee joint. There are different treatment options and we assessed the treatment outcomes of various procedures. Methods: This case series was conducted using probability consecutive sampling technique in the Department Orthopedics Surgery, Combined Military Hospital, Lahore from December 2011 to March 2016 in a duration of five years four months. Our sample size was fifteen patients between 32 to 60 years of age with giant cell tumor. We included all patients with giant cell tumors newly diagnose on history, clinical examination, radiographs, magnetic resonance image (MRI) and bone biopsy. We excluded all patient with history of previous surgery, uncontrolled diabetes, chronic liver failure, chronic kidney disease and congestive heart failure. We managed all patients with various treatment option included resection arthrodesis with vascular fibular graft, mega prosthesis, and wide margin excision with bi-focal segment transport with external fixator device. We observed treatment effectiveness, limb length discrepancy, and post treatment complications. Our follow up period was four years. We followed all patients six monthly for one year and subsequently at one year. Results: There were 13 (86.7%) male and two (13.3%) females. Majority seven (46.67%) patients were present between 41 to 50 years of age with their mean±SD (30.66±13.87). Amongst three (20%) patients with involvement of proximal humerus, resection arthrodesis with vascular fibular graft was done, three (20%) patients with distal radius, two (66.66%) had resection arthrodesis with vascular fibular graft and one (33.34%) had mega prosthesis. Two (13.3%) had resection arthrodesis (50%) and mega prosthesis (50%). Majority five (33.3%) had proximal tibia involvement were treated with three (60%) resection arthrodesis and two (40%) with mega prosthesis. Among Two (13.3%) patients who had distal tibia involved were managed with wide margin excision, and bi focal segment transport with external fixator device. Out of the total 15 cases, nine (60%) had lower limb involvement and there was only one (11.11%) leg length discrepancy. Conclusion: We concluded from the study that management of giant cell tumors with mega prosthesis, segment trans port and resection with free fibular graft was equally good, but patient satisfaction was better in patients who had resection with mega prosthesis.