Trabecular Metal Augmented Reconstruction of Acetabular Defect after Removal of Periacetabular Giant Cell Tumors in A Young Male: A Case Report with Review of Literature
Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 8-12 | Apurv Gabrani, Hitesh Dawar, Surbhit Rastogi, Deepak Raina. DOI:0.13107/jbst.2021.v07i03.57
Author: Apurv Gabrani , Hitesh Dawar , Surbhit Rastogi , Deepak Raina
 Department of Orthopedic, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
Address of Correspondence
Dr. Apurv Gabrani,
Department of Orthopedic, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India.
Introduction: Giant cell tumors (GCTs) are benign, epiphyseal, locally aggressive bone tumors. Pelvic GCTs are sparingly encountered and present a challenging scenario for the surgeon to not only diagnose but also to treat appropriately. Multiple treatment options are available as per the literature but no single approach is universally accepted. Moreover, due to the complex anatomy of the pelvis, novel treatment options have also been tried.
Case Report: A 30-year-old male presented to the outpatient clinic with complaints of gradually progressive dull aching pain in his right hip for 6 months. On radiological investigation, he was found to have a lytic lesion in the right periacetabular region. Image-guided biopsy revealed GCT on histopathological examination. The final management included extended curettage of the tumor and reconstruction of the remaining defect with trabecular metal (TM) augment supplemented with reconstruction plate. The patient resumed full activity and remains asymptomatic and disease free at 5 years follow-up.
Conclusion: To the best of our knowledge, this is the first reported case for the use of TM augment in reconstruction of bone defect following curettage for GCT in pelvis.
Keywords: Giant cell tumor pelvis, trabecular metal, acetabular reconstruction.
1. Karpik M. Giant cell tumor (tumor gigantocellularis, osteoclastoma)-epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil 2010;12:207-15.
2. Trieb K, Bitzan P, Lang S, Domikus M, Kotz R. Recurrence of curetted and bone grafted giant-cell tumors with and without adjuvant phenol therapy. Eur J Surg Oncol 2001;27:200-2.
3. Boons HW, Keijser LC, Schreuder HW, Pruszczynski M, Lemmens JA, Veth RP. Oncologic and functional results after treatment of giant cell tumors of bone. Arch Orthop Trauma Surg 2002;122:17-23.
4. Blake SM, Gie GA. Large pelvic giant cell tumor-a case report and a review of current treatment modalities. J Arthroplasty 2004;19:1050-4.
5. Reid R, Banerjee SS, Sciot R. Giant cell tumour. In: Fletcher CD, Unni KK, Mertens F, editors. Pathology and Genetics of Tumors of Soft Tissue and Bone. Lyon, France: IARC Press; 2002. p. 309-13.
6. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 1978;60:731-46.
7. Sanjay BK, Frassica FJ, Frassica DA, Unni KK, McLeod RA, Sim FH. Treatment of Giant cell tumor of the pelvis. J Bone Joint Surg Am 1993;75:1466-75.
8. Moore AT. The Moore self-locking vitallium prosthesis in fresh femoral neck fractures: A new low posterior approach (the southern exposure). In: American Academy of Orthopaedic Surgeons: Instructional Course Lectures. Vol. 16. St. Louis: CV Mosby; 1959.
9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end‐result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.
10. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg 1982;64A:755-61.
11. Zheng K, Yu X, Hu Y, Wang Z, Wu S, Ye Z. Surgical treatment of pelvic giant cell tumor: Amulti-center study. World J Surg Oncol 2016;14:104.
12. Zheng K, Wang Z, Wu S, Ye Z, Xu S, Xu M, et al. Giant cell tumor of the pelvis: Asystematic review. Orthop Surg 2015;7:102-7.
13. Breitenseher M, Dominkus M, Scharitzer M, Lechner M, Trieb K, Imhof H, et al. Diagnostic imaging of giant cell tumors. Radiologe 2001;41:568.
14. Agarwal S, Agarwal T, Agarwal R, Agarwal PK, Jain UK. Fine needle aspiration of bone tumors. Cancer Detect Prev 2000;24:602-9.
15. Goto T, Lijima T, Kawano H, Yamamoto A, Arai M, Matsuda K, et al. Serum acid phosphatase as a tumour marker in giant cell tumuor of bone. Arch Orthop Trauma Surg 2001;121:411-3.
16. Caudell JJ, Ballo MT, Zagars GK, Lewis VO, Weber KL, Lin PP, et al. Radiotherapy in the management of giant cell tumor of bone. Int J Radiat Oncol Biol Phys 2003;57:158-65.
17. Marcove RC, Weis LD, Vaghiawalla MR, Pearson R. Cryosurgery in the treatment of giant cell tumors of bone: A report of 52 consecutive cases. Clin Orthop Relat Res 1978;134:275-89.
18. Guo W, Sun X, Zang J, Qu H. Intralesional excision versus wide resection for giant cell tumor involving the acetabulum: Which is better? Clin Orthop Relat Res 2012;470:1213-20.
19. Leggon RE, Zlotecki R, Reith J, Scarborough MT. Giant Cell tumor of the pelvis and sacrum: 17 Cases and analysis of the literature. Clin Orthop Relat Res 2004;423:196-207.
20. Labs K, Perka C, Schmidt RG. Treatment of stages 2 &3 giant cell tumor. Arch Orthop Traum Surg 2001;121:83-6.
21. Thomas JL, Jaffe KA. Use of polymethylmethacrylate in large osseous defects in the foot and ankle following tumor excision. J Foot Ankle Surg 1999;38:208-13.
22. Patradul A, Kitidurmrongsook P, Parkpian V, Ngarmukos C. Allograft replacement in giant cell tumor of the hand. Hand Surg 2001;6:59-65.
23. Meneghini RM, Meyer C, Buckley CA, Hanssen AD, Lewallen DG. Mechanical stability of novel highly porous metal acetabular components in revision total hip arthroplasty. J Arthroplasty 2010;25:337-41.
24. Grappiolo G, Loppini M, Longo UG, Traverso F, Mazziotta G, Denaro V. Trabecular metal augments for the management of paprosky Type III defects without pelvic discontinuity. J Arthroplasty 2015;30:1024-9.
25. Horisberger M, Paul J, Wiewiorski M, Henninger HB, Khalifa MS, Barg A, et al. Commercially available Trabecular metal ankle interpositional spacer for tibiotalocalcaneal arthrodesis secondary to severe bone loss of the ankle. J Foot Ankle Surg 2014;53:383-7.
26. Sporer SM, Paprosky WG. The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplasty 2006;21 Suppl 6:83-6.
27. Balke M, Streitbuerger A, Budny T, Henrichs M, Gosheger G, Hardes J. Treatment and outcome of giant cell tumors of the pelvis. Acta Orthop 2009;80:590-6.
28. Huang HC, Hu YC, Lun DX, Ma J, Xia Q, Ji J, et al. The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum. Zhonghua Gu Ke Za Zhi 2011;31:635-9.
29. Mori Y, Tsuchiya H, Karita M, Nonomura A, Nojima T, Tomita K. Malignant transformation of a giant cell tumor 25 years after initial treatment. Clin Orthop Relat Res 2000;381:185-91.
30. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.
|How to Cite this article: Gabrani A, Dawar H, Rastogi S, Raina D | Trabecular metal augmented reconstruction of acetabular defect after removal of periacetabular giant cell tumors in a young male: A case report with review of literature. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 8-12.|