Periprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.
Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.
Introduction. Giant-cell tumor of bone (GCTB) is a benign tumor with an unpredictable evolution, representing 4-5% of all primary bone tumors and 15% of benign bone tumors usually affecting 20-45 years old adults. The predilect location is the distal femur, proximal tibia, and distal radius. Case presentation. We report the case of a 31-year-old male, regardless of medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the right knee, after suffering a traumatic event. Clinical examination and imaging tests established the diagnosis of lateral femoral condyle fracture. Therefore, osteosynthesis with 4 screws was performed. Postoperative evolution was uneventful until one year later when the patient presented to the ED for pain and inflammatory aspect of the right knee, but with no history of trauma during this time. The imagistic exams of the right knee (X-ray, magnetic resonance imaging and scintigraphy) detected a tumor of the lateral femoral condyle that also affected the osteosynthesis material. Thus, the removal of screws and histopathological exam were performed, the latter establishing the diagnosis of GCTB. Taking into consideration radiological and histological aspects of the tumor and relating them to the clinical findings, the GCTB was classified in stage III Enneking. The patient underwent surgery, segmental resection of the tumor in oncological limits and arthroplasty with modular tumoral prosthesis was performed. Postoperative results at 6 and 12 months according to Musculoskeletal Tumor Society Scoring System were very good. The key feature of this case consists of post-osteosynthesis appearance of the GCTB given the fact that only 3 cases of GCTB affecting the screw site were reported in literature.
Introduction: The aim of the study was to report the clinical and functional outcomes in patients undergoing limb salvage with various reconstruction techniques in primary malignant bone tumor.Materials and methods: This study was performed between 2011 and 2018 on 52 patients with primary malignant bone tumors admitted to the Department of Orthopaedics and Traumatology of University Emergency Hospital, Bucharest. All the patients underwent surgical treatment (resection-reconstruction technique) followed by oncologic therapy. The mean follow-up was 3 years and 8 months and the minimum follow-up was 12 months.Results: The best results were obtained in patients in whom resection of the tumor followed by reconstruction was possible, without affecting the adjacent joint through arthrodesis or arthroplasty. These patients had an average MSTS score of 75.2%. The patients who underwent reconstruction procedures by endoprosthesis also had good results with an average MSTS score of 72.3%, while patients with arthrodesis obtained rather modest results – the average MSTS score being 67.3%. When taking into consideration the location of tumors, the best MSTS scores were obtained in patients with tumors of the distal radius – 80%, followed by femoral and humeral diaphysis – 75.6%, distal femur – 75.2%, proximal femur – 73.3%, proximal humerus – 72.3%, tibial diaphysis – 72.2%, distal tibia – 70% and proximal tibia 68.7%.Conclusions: The orthopedist must judiciously chose the surgical technique, taking into consideration the anatomical particularities and the needs of the patient. Given the functional results and the emotional acceptability, reconstruction with tumor prosthesis represents the first option.
The GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.
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