Resection and Arthrodesis of the Knee Joint by Different Modalities for Aggressive Giant Cell Tumors of Bone
Volume 3 | Issue 1 | May- Aug 2017 | Page 17-21 | Y. J. Mahale, Shubham Mishra, Sagar Chinchole
Authors: Y. J. Mahale , Shubham Mishra , Sagar Chinchole .
Departmnet of Orthopedics, ACPM Medical College, Dhule, Maharashtra, India,
Address of Correspondence
Dr. Shubham Mishra,
ACPM medical college ,
Dept of orthopaedics, room no 604,
pg boys hostel ,saakri road dhule, 424001
Email : email@example.com
Purpose: The aim is to evaluate the functional outcomes inCampanacci Grade 3 giant cell tumor (GCT)of distal femur and proximal tibia treated with wide resection and arthrodesis with different implants used such as long intramedullary interlocking nail(n=11),long Kuntscher nail(n=2), and DCP plate(n=3) andto compare the outcomes and functional results of arthrodesis with arthroplasty which were done elsewere.GCTis a aggressive benign bone tumorseen in young patients with a normal life expectancy. Campanacci Grade 3 tumors and recurrent tumors require wide resection[1,2].Arthrodesis is an alternativeoptions for reconstruction in Campanacci Grade 3,though Arthroplasty is ideal option for campannci Grade 3 tumors.
Methods: Criteria included 16 patients of Campanacci Grade 3 GCT in which 14 male and 2 female around aged between 20and 60 years with a mean age of 30 years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur(n=7) or proximal tibia(n= 9).After wide resection,2 struts were fashioned from the harvested fibula of thesame side and inserted into medullary canal at the resected ends of the tibia and femur.Cancellous bone grafts were taken from thesame side of theiliac crest.Hemicylindrical graft was taken from anteriorpart of either distal femur or proximal tibia. A long intramedullary interlocking nail was inserted inretrograde fashion through piriformis fossa to distal tibia.Cancellous bone grafts[2,3]were placed transversely along the struts and circumferentially over the host-graft junctions.For other patients, long Kuntscher nail and DCP plate with K-wirewere used.Results of arthrodesis were evaluated those in which long intramedullary interlocking nail(n=11), long Kuntscher nail(n=2),and DCP (n=3).Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere.
Results: Patients were followed up for a mean of 12 years. All patients were ofCampanacciGrade 3.The mean size of tumors was 12-10-7cm.All patients achieved arthrodesis with intramedullary interlocking nail, Kuntscher nail,and plating.A total number of patient (n=16).The mean bone union time was 12-14 weeks. There was no loss of alignment,loosening, and no implant breakage. The mean musculoskeletal tumor society score was 27(87%of full score). The complications were evaluated in which patients were having skin necrosis(n=3),skin infection (n=2),and peroneal nerve injury(n=1).
Conclusions: In aggressiveCampanacciGrade 3 GCT around theknee joint,arthrodesis [6,7]withlong intramedullary interlocking nail provides good results. Longintramedullary interlocking nailing in arthrodesisprovides high fusion rates, minimal shortening,and rotational stability as compared to plate fixation. Arthrodesis is acost-effective method as compared to arthroplasty in economically constrained population of developing nations and shows good functional outcomes with acceptable morbidity.
Keywords: Giant cell tumor, arthrodesis, intramedullary interlocking nail, hemicylindrical graft, fibula transposition, bone transplantation.
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|How to Cite this article: Mahale Y. J, Mishra S, Sagar Chinchole S. Resection and Arthrodesis of the Knee Joint by Different Modalities for Aggressive Giant Cell Tumors of Bone. Journal of Bone and Soft Tissue Tumors Jan-Apr 2016;2(1): 17-21.|