Total knee arthroplasty with Mesh technique in management of juxta-articular giant cell tumor around the knee

Authors

  • Abdul Rahim Department of Orthopaedics, NIMS University, Shobhanagar, Jaipur, Rajasthan
  • Mukesh Tiwari Department of Orthopaedics, NIMS University, Shobhanagar, Jaipur, Rajasthan
  • Gaffar Khan Department of Orthopaedics, NIMS University, Shobhanagar, Jaipur, Rajasthan
  • Gaurav Gupta Department of Orthopaedics, NIMS University, Shobhanagar, Jaipur, Rajasthan
  • Saurabh Sharma Department of Orthopaedics, NIMS University, Shobhanagar, Jaipur, Rajasthan

Keywords:

GCT, TKR, Mesh

Abstract

Background:Giant Cell Tumors (GCT) of bone are aggressive and potentially malignant lesions. Still it is one of difficult and challenging problem because there are no absolute clinical, radiographic or histological parameters that accurately predict the propensity of any single lesion to recur or metastasize. Eighty per cent of the GCT have a benign course, with a local recurrence rate of 10-50%; about 10% of GCT undergo malignant transformation through their recurrences. The main aim of the management of GCT is to eliminate the tumor and still save the joint function. We present our experience with long stem prosthetic total knee arthroplasty for juxta articular giant cell tumors around the knee.

Methods:Fourteen patients of juxta articular giant cell tumor around the knee were treated in our institute during the period 2008 to 2014 underwent resection and replacement by long stem arthroplasty with mesh were analyzed in this study. Patients were evaluated depending upon pain (Visual analogue score), range of movement, infection, pathological fracture and recurrence of tumor.  

Results:Excellent results were obtained in all 12 patients (85.71%) and 2 patients had good (14.29%) results in case of TKR with mesh in this study.

Conclusions: Total knee arthroplasty with mesh is effective in achieving the desired goals of reconstruction with good functional results, least complications in selected patients and no recurrence.

References

Eckardt JJ, Grogan TJ. Giant cell tumor of bone. Clin Orthop Relat Res. 1986;204:45-58.

Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am. 1982;64:755-61.

Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res. 2002;400:201-10.

Szendroi M. Giant-cell tumors of bone. J Bone Joint Surg Br. 2004;86:5-12.

McGrath PJ. Giant-cell tumors of bone: an analysis of fifty-two cases. J Bone Joint Surg Br. 1972;54:216-29.

Vidyadhara S, Rao SK. A novel approach to juxta-articular aggressive and recurrent giant cell tumours: Resection arthrodesis using bone transport over an intramedullary nail. Int Orthop. 2007;31(2):179-84.

Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109-15.

Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements. J Bone Joint Surg Am. 1999;81:462-8.

Natarajan MV, Annamalai K, Williams S, Selvaraj R, Rajagopal TS. Limb salvage in distal tibial osteosarcoma using a custom mega prosthesis. Int Orthop. 2000;24:282-4.

Enneking WF. Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In: Enneking WF, eds. Bristol-Myers/Zimmer Orthopaedic Symposium. Limb Salvage in Musculoskeletal Oncology. 1st ed. New York: Churchill Livingstone; 1987: 626-639.

Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69:106-14.

Yu Ping Su, Wei Ming Chen, Tain Hsuing Chen. GCT of bone: an analysis of 87 cases. Int Orthop. 2004;28:239-43.

Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006;37:35-51.

Pettersson H, Rydholm A, Persson B. Early radiologic detection of local recurrence after curettage and acrylic cementation of giant cell tumours. Eur J Radiol. 1986;6:1-4.

Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, et al. Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop. 2008;79:86-93.

Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002;397:248-58.

Conrad EUIII, Enneking WF, Spingerfield DS. Giant cell tumour with curettage and cementation. In: Enneking WF, eds. Limb Salvage in Musculoskeletal Oncology. 1st ed. New York: Churchill livingstone; 1987: 516-519.

Saiz P, Virkus W, Piasecki P, Templeton A, Shott A, Gitelis S. Results of giant cell tumous treated with intralesional excision. Clin Orthop Relat Res. 2004;424:221-6.

Scully SP, Mott MP, Temple HT, O’Keefe RJ, O'Donnell RJ, Mankin HJ. Late recurrence of giant-cell tumor of bone. A report of four cases. J Bone Joint Surg Am. 1994;76:1231-3.

Laurin S, Ekelund L, Persson B. Late recurrence of giant-cell tumor of bone: pharmacoangiographic evaluation. Skeletal Radiol. 1980;5:227-31.

Marcove RC. A 17-year review of cryosurgery in the treatment of bone tumors. Clin Orthop. 1982;163:231-4.

Marcove RC, Lyden JP, Huvos AG, Bullough PG. Giant cell tumors treated by cryosurgery. J Bone Joint Surg. 1973;55A:1633-44.

Marcove RC, Sheth DS, Brien EW, Huvos AG, Healey JH. Conservative surgery for giant cell tumors of the sacrum. The role of cryosurgery as a supplement to curettage and partial excision. Cancer. 1994;74:1253-60.

Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, Huvos AG. Cryosurgery in the treatment of giant cell tumor of bone. A report of 52 consecutive cases. Cancer. 1978;41:957-69.

Hutter RVP, Worcester JN Jr, Francis KC, Foote FW Jr, Stewart FW. Benign and malignant giant-cell tumor of bone. A clinicopathological analysis of the natural history of the disease. Cancer. 1962;15:653-90.

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Published

2016-12-11

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Original Research Articles