A Tertiary Care Centre Experience of Recurrent Giant Cell Tumor Around the Knee Joint (original) (raw)
Related papers
Resection arthrodesis for giant cell tumors around the knee
Indian Journal of Orthopaedics, 2007
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. As the patients affected with GCT are young or middle-aged adults with a normal life expectancy, arthrodesis is an attractive option for reconstruction in these patients. Materials and Methods: Thirty-six patients of mean age 33.1 years with Campanacci Grade III giant cell tumors around the knee (20 distal femoral and 16 proximal tibial) were treated with wide resection and arthrodesis from January 1996 through January 2006. Arthrodesis was performed using plating with free fibular graft (n = 18), IM nail with free fibular graft (n = 8) and IM nail combined with ring fixator using bone transport (n = 10). Results: Fusion after the first surgery was achieved in 77.7%, 75% and 90% of the patients in the three groups respectively. Local recurrence was seen in two patients and repeat surgery for nonunion/ graft fracture had to be done in four patients and two patients in the plating and nailing groups respectively. Conclusion: Wide resection and arthrodesis in aggressive GCTs around the knee is a good treatment option. IM nail combined with a ring fixator seems to be a good method of arthrodesis with high fusion rates, least shortening and early rehabilitation.
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...
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 ...
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...
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.
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.
Curettage and reconstruction by the sandwich technique for giant cell tumours around the knee
Journal of orthopaedic surgery (Hong Kong), 2014
To evaluate outcomes of 36 patients who underwent curettage, use of phenol, and reconstruction using the sandwich technique for giant cell tumour (GCT) of bone around the knee. 22 women and 14 men aged 19 to 46 (mean, 29.6) years underwent intralesional curettage, use of phenol, and reconstruction using the sandwich technique for GCT of the proximal tibia (n=23) or distal femur (n=13). Two of the cases were recurrences. Two, 18, and 16 tumours were classified as grade I, grade II, and grade III, respectively. Five of the grade III tumours were associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique). Pathological fractures were fixed with plates. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up period was 5 (2.5-11) years. The mean MSTS score was 27.7 out of 30 (standard deviation, 3; ran...
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.
HSS Journal, 2009
Giant cell tumors are neoplasms of mesenchymal stromal cells with varied manifestations. There is no uniform accepted treatment protocol for these tumors. Curettage, although an accepted method of treatment, carries a high local recurrence rate. Adjuvant therapies including high-speed burr debridement, cryotherapy, and phenol treatment have been advocated to reduce local recurrence. We have used these adjuvants to determine if improved cure rate with improved outcomes could be attained with regard to local tumor control and functional outcome. Twenty-eight cases of proven giant cell tumors of the distal femur and proximal tibia were included in this prospective case series. The lesions were at the upper tibia in 14 cases and the lower femur in 14 patients. The patients were evaluated clinically, radiologically, and by histological examination. Companacci grading and Enneking staging were determined. The treatment was done in the following steps: Curettage and further debridement with a high-speed burr, cryotherapy, impaction of the cavity with subchondral iliac crest bone graft, and, finally, cementation with or without internal fixation. Functional evaluation was done by Enneking's system. The follow-up time was between 24-40 months with a mean of 34 months. The functional results of the procedure were rated as good to excellent with a mean of 93.9%. This technique has the advantages of joint preservation, excellent functional outcome, and low recurrence rate when compared with other treatment modalities. For these reasons, it is recommended as an adjuvant to curettage for most giant cell tumors of bone.
Annals of Medicine and Surgery, 2019
This study is to evaluate the outcomes of En bloc resection and reconstruction in patients with GCT of the bone around the knee and in the distal radius. Materials and methods: We reviewed 41 cases of GCT of the bone that was treated by En bloc resection around the knee joint and in the distal radius from 2011 to 2018. The local recurrence, metastases, complications and functional score were evaluated for each operation technique. Results: The average of MSTS score for all group was 78% (excellent). In the knee joint, the megaprostheses group had an excellent MSTS score of78.9% and good 21.1%. The MAMC group had an excellent MSTS score of40.0%, good 50.0% and fair 10.0%. One patient in the megaprostheses group had metastasis to the lung and 1 patient in the knee arthrodesis group has a recurrence. Infection occurred in 2 cases of megaprostheses while only 1 case in MAMC. Both of the groups in knee joint GCT had 1 patient with implant loosening. In the distal radius, FVFG group had an excellent MSTS score 100% and NVFG group had an excellent score 77.7%, good 11.1% and fair 11.1%. One patient in the NVFG group had an infection, 1 patient has implant loosening and another one patient had graft failure. Two patients in the NVFG group had a recurrence. No metastasis was found in both of the group types of surgery in distal radius GCT. Conclusion: Functional outcome of a patient with GCT of the bone after En bloc resection and reconstruction with the above techniques had comparable results with previous studies.