Limb salvage surgery for giant cell tumours around knee joint: a single institute experience

Authors

  • Amritha Prabha Department of Surgical Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
  • Urvish K. Shah Department of Surgical Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
  • M. S. Ganesh Department of Surgical Oncology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India
  • Hiranya K. Seenappa Department of Orthopaedics, Vydehi Institute of Medical Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20214190

Keywords:

Giant cell tumour, Segmental resection, Endoprosthesis, Score, Local recurrence

Abstract

Background: Giant cell tumours (GCTs) of bone are benign but locally aggressive tumours. The surgical treatment of GCTs in the around knee joint mainly includes curettage and bone grafting, extended curettage and cement filling, segmental resection and modular endo prosthesis reconstruction.

Methods: Retrospective analysis of the presentation, the functional outcome following modular endoprosthetic reconstruction, prosthetic survival and the recurrence rate in 17 patients with Campanacci grade 3 GCTs involving distal femur and proximal tibia, who underwent segmental resection and modular endoprosthesis reconstruction in a single centre from 2015 to 2018. The surgery was performed according to the general principles of limb salvage surgery and modular segmental replacement was used. All stems were cemented in place. Isometric exercises and mobilization with crutches were started on 2nd postoperative day. Knee joint bending was started for proximal tibia patients after 2 to 3 weeks. Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Immediate post-operative complication like delayed wound healing, flap necrosis, wound infection, foot drop, leg length discrepancies were evaluated.

Results: The average MSTS functional score was 78%.3 year prosthetic survival was 100%. None of the patients had recurrence. One patient had left lower lobe metastasis for which wedge resection was done.

Conclusions: Segmental resection and endoprosthetic replacement has good functional outcome in patients with tumours around the knee joint. As GCTs are tumours with less chance of local and distant metastasis after complete excision, endoprosthetic prosthesis is a good treatment option after complete excision.

References

Turcotte RE. Giant cell tumour of bone. Orthop Clin North Am. 2006;37(1):35-51.

Cooper AP, Travers B. Surgical essays, vol. I. London 7 Cot and Son and Longman & Co. 1818.

Ne´laton E. D’une nouvelle espe`ce de tumeur be´nigne des os ou tumeur a` mye´loplaxes. Paris7 Adrien Delahaye. 1886.

Virchow R. Die Krankhaften Geschwulste. Berlin7 Hirschwald. 1846;2.

Reid R, Banerjee S, Sciot R. Giant cell tumour, in The WHO Classification of tumors. Pathology and genetics: tumors of soft tissue and bone. Fletcher D, Unni K, Mertens F, Editors. Lyon, France, IARC Press. 2002.

Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, et al. Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am. 2012;94:461-7.

van der Heijden L, van de Sande MA, Heineken AC, Fiocco M, Nelissen RG, Dijkstra PD. Mid-term outcome after curettage with polymethylmethacrylate for giant cell tumor around the knee: higher risk of radiographic osteoarthritis? J Bone Joint Surg Am. 2013;95:159.

Grimer RJ, Aydin BK, Wafa H, Carter SR, Jeys L, Abudu A, et al. Very longterm outcomes after endoprosthetic replacement for malignant tumours of bone. Bone Joint J. 2016;98B:857-64.

Enneking WF, Dunham W, Gebhardt MC. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241-6.

Natarajan MV, Prabhakar R, Mohamed SM, Shashidhar R. Management of juxta articular giant cell tumors around the knee by custom mega prosthetic arthroplasty. Indian J Orthop. 2007;41:134-8.

Campanacci M, Baldini N, Boriani S, Sudanese A. Giantcell tumor of bone. J Bone Joint Surg Am. 1987;69(1):106-11.

Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;415:4-18.

Zhen W, Yaotian H, Songjian L, Ge L, Qingliang W. Giant-cell tumour of bone. The long-term results of treatment by curettage and bone graft. J Bone Joint Surg Br. 2004;86(2):212-6.

Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS, Ezane AM. Aggressive giant cell tumour of bone. Singap Med J. 2006;47:680.

Gaston CLL, Goulding K, Grimer RJ. The use of endoprostheses in musculoskeletal oncology. Oper Tech Orthop. 2014;24:91-102.

Sharil A, Nawaz A, Azman MN, Zulmi W, Faisham WI. Early functional outcome of resection and endoprosthesis replacement for primary tumor around the knee. Malays Orthop. 2013;7:30-5.

Biau D, Faure F, Katsahian S Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am. 2006;88:1285-93.

Deheshi BM, Jaffer SN, Griffin AM, Ferguson PC, Bell RS, Wunder JS. Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res. 2007;459:96-104.

Balke M, Ahrens H, Streitbuerger A, Koehler G, Winkelmann W, Gosheger G, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol. 2009;135:149-58.

Muherumu A, Niu X. Pulmonary metastasis in giant cell tumour of bones. World J Surg Oncol. 2014,12:261.

Rock MG. Curettage of giant cell tumour of bone: factor influencing local recurrences and metastasis. Chir Organi Mov. 1990;75:204-5.

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Published

2021-10-26

Issue

Vol. 7 No. 6 (2021): November-December 2021

Section

Original Research Articles