Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee

Abstract

Background:Segmental resection of bone in Giant Cell Tumor (GCT) around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered.Materials and Methods:Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven) of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years).Resection arthrodesis with telescoping (shortening) over intramedullary nail (n=5), resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail (n=3) and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening (n=5) were the procedure performed.Results:Shortening was the major problem following resection arthrodesis with telescoping (shortening) over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure.After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (∼15cm) was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm) and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an ilizarov fixator. The complications were superficial infection (n=5), stress fracture of fibula (n=2). The stress fracture fibula required DCP fixation and bone grafting. The usual time taken for union and limb length equalization was approximately one year.Conclusion:Resection arthrodesis with intercalary dual fibular autograft and cortico-cancellous bone grafting with simultaneous limb lengthening achieved limb length equalization with relatively short morbidity.

Clinical outcome of various limb salvage surgeries in osteosarcoma around knee: Megaprosthesis, extracorporeal irradiation and resection arthrodesis

“…Four patients had a nonunion while four patients had spontaneous fatigue fractures of their grafts. All sites of nonunion subsequently healed four to 11 months after supplementary iliac bone grafting [35].…”

Outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

“…Moreover, in our opinion the surgical technique is easier and is associated with greater respect for soft tissues compared to the use of monoblock implants. Radiological outcomes of B2/B3-type PPFs, according to Beal and Tower, is good or more often excellent when modular long stems are implanted in revisions whatever fixation system is used 3,14,24,25 14,21 . These excellent results are probably related to avoiding the use of cement, which could leak to the fracture site and impede fracture healing 14,26 .…”

Management of infected custom mega prosthesis by Ilizarov method

“…Knee arthrodesis was planned by managing the bone gap by Ilizarov method as shown in Figure 6. 3,4 The prosthesis was removed as in Figure 6. Thorough debridement was done.…”