Resection arthrodesis for the management of aggressive giant cell tumor of the distal femur

Abstract

Background:Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent, and extensive tumors. Wide resection and mobile joint reconstruction are preferable for treating tumors around the knee. In certain situations, resection arthrodesis or an amputation is suggested. In this prospective study we report the outcome of 8 patients of aggressive GCT of lower end of femur treated with resection arthrodesis.Materials and Methods:Eight patients with mean age of 37.25 years (range 30–45 years) with Campanacci Grade III (Enneking stage III) giant cell tumors at the distal femur were treated with wide resection and arthrodesis using dual free fibular graft and locked intramedullary nail from January 2003 to January 2008. There were four males and four females patients. The mean follow-up was 48.75 months (range 30–60 months). The functional evaluation was done using the standard system of musculoskeletal tumor society with its modification developed by Enneking et al.Results:At the final follow up the functional score ranged from 20 to 27 out of total score of 30. Graft union was achieved in all cases in a duration mean of 14.5 months (range 12-20 months).One case required secondary bone graft due to delayed union, and one case had superficial wound infection which healed on systemic antibiotics. At final followup, all the patients were disease free.Conclusion:Wide resection and arthrodesis in aggressive GCTs of the distal femur with involvement of all muscle compartments is a good treatment option. Resection arthrodesis offers a biological reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.

Joint salvage and biological repair of massive-cavity bone defects after extensive curettage of giant cell tumor around the knee with vascularized fibular autograft and cancellous allograft

“…Knee arthrodesis reconstructed by structural bone allograft or autograft after En-bloc resection of GCT is not recommended since most of these GCT patients are young and active, and wish to retain a functional knee [7][8][9][10]. Moreover, structural bone grafts may also lead to certain complications, including fracture, nonunion, infection, GCT recurrence, and donor complications associated with non-vascularized bular autograft [11].…”

Expression of ezrin, CD44, and VEGF in giant cell tumor of bone and its significance

“…Giant cell tumor of bone (GCTB), a primary tumor of bone, frequently occurs in metaphysis of long bones, especially in the distal femur and proximal tibia [ 1 , 2 ]. It has a high recurrence rate after surgery with involvement of joints and their surrounding soft tissues and even causes serious dysfunction.…”

Differential Expression of ADAM23, CDKN2A (P16), MMP14 and VIM Associated with Giant Cell Tumor of Bone

“…This neoplasm usually affects young adults - approximately two-thirds of the patients are between 20 and 40 years of age 3 . GCTB most commonly involves the distal femur, proximal tibia, distal radius, proximal humerus and the sacral bone, with a slight predominance in females 4 , 5 .…”

“…The World Health Organization has classified GCTB as an aggressive, potentially malignant lesion 4 . Clinically, GCTB is considered benign, but it often becomes an aggressive lesion with a tendency for local recurrence.…”