Joint Salvage Using Sandwich Technique for Giant Cell Tumors around Knee

Abstract

The most common site for giant cell tumors (GCT) is knee, where the tumor characteristically extends right up to the subarticular bone plate. Extensive curettage with preservation of the joint should be done wherever possible. The alternatives for filling the void left after curettage are either bone graft or bone cement. Sandwich technique uses the advantages of both, taking care to prevent damage to articular cartilage. This study was done to evaluate the results of sandwich technique in tumors around the knee joint. It was a prospective study of 26 consecutive patients (15 females and 11 males) with Campanacci grade II and grade III GCT around the knee, which qualified the inclusion criterion and underwent knee reconstruction with sandwich technique, after extended curettage of the tumor. The mean age of the patients at the time of surgery was 32.73 ± 11.30 years (range, 18-62 years), and the mean follow-up was 3.87 ± 1.26 years (range, 6.5-2 years). At final follow-up, the functional evaluation was done using Musculoskeletal Tumor Society (MSTS) score and measuring range of motion around the knee. Three patients had recurrence of tumor; in one case, we were able to salvage the joint and repeat sandwich surgery was performed, and in the other two cases, the joint was breached; therefore, we resorted to resection arthrodesis. At final follow-up, the mean functional arc of motion around the knee and the mean MSTS score in patients without arthrodesis was 123.52 ± 10.21 degrees (range, 100-130 degrees) and 27.04/30, respectively; all patients were able to do their activities of daily living with ease. Sandwich technique is a good reconstruction procedure in GCT around knee joint with good survival rate, minimal complications, and good functional outcome.

A rare concurrence of giant cell tumor and Myasthenia gravis

“…The alternatives for filling the void left after curettage are either bone graft or bone cement. Sandwich technique uses the advantages of both, taking care to prevent damage to articular cartilage [6] . It doesn't get any easier when we plan the same technique in a patient of myasthenia gravis, lot of odds comes into existence, right from the risks of having or developing other autoimmune diseases like Rheumatoid arthritis or SLE during the course of treatment, but also the post-operative complications like recurrence.…”

“…It usually develops in long bones but can occur in unusual locations [1] . GCT accounts for 5% of all primary bone tumors and 20% of benign skeletal tumors (5)(6)(7).…”

Navigation assisted primary total knee arthroplasty sixteen years after gaint cell tumor distal femoral cement augmentation

“…There is ongoing debate whether cement or bone graft is the best defect filler. Some studies report good results with bone graft [9,10] , although other groups support the use of cementation [11,12,13] or both graft and cement [14] .Wada et al [15] . Reported cementation to be safe choice for structural support with a low risk of osteoarthritis.…”

Primary Total Knee Arthroplasty Twenty Years after Distal Femoral Cement Augmentation of a Giant Cell Tumor

“…There is ongoing debate whether cement or bone graft is the optimal defect filler. Some studies report good results with bone graft [ 11 , 12 ], although other groups support the use of cement [ 13 – 15 ] or both graft and cement [ 16 ]. Wada et al [ 17 ] reported cement use to be safe for structural support with a low risk of osteoarthritis.…”