Limits...
Inactivated autograft-prosthesis composite has a role for grade III giant cell tumor of bone around the knee.

Xu S, Yu X, Xu M, Fu Z - BMC Musculoskelet Disord (2013)

Bottom Line: No recurrence, metastasis, prosthesis loosening were found.The healing time in femoral lesion is faster than that in tibial lesion.The technique of alcohol inactivated autograft-prosthesis composite could be able to achieve satisfactory oncological and functional outcomes in Grade III GCT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics, General Hospital of Ji'Nan Military Region, Ji'Nan 250031, China. yxch48@vip.sina.com.

ABSTRACT

Background: Giant cell tumors (GCT) around the knee are common and pose a special problem of reconstruction after tumor excision, especially for grade III GCT. We questioned whether en bloc resection and reconstruction with alcohol inactivated autograft-prosthesis composite would provide (1) local control and long-term survival and (2) useful limb function in patients who had grade III GCT around the knee.

Methods: We retrospectively reviewed eight patients (5 males and 3 females) treated with this procedure with mean age of 31 years (range 20 to 43 years) from Jan 2007 to Oct 2008. 5 lesions were located in distal femur and 3 in proximal tibia. 4 patients were with primary tumor and the other 4 with recurrence. 2 patients showed pathological fracture.

Results: Mean Follow-up is 54 months ranging from 38 to 47 months. No recurrence, metastasis, prosthesis loosening were found. The mean healing time between autograft and host bone was 5.5 months. The mean MSTS score was 26.3 (88%) ranging from 25 to 29. The mean ISOLS composite graft score was 32.8 (88.5%) ranging from 28 to 35. Creeping substitution is possibly the main way in bony junction. The healing time in femoral lesion is faster than that in tibial lesion.

Conclusions: The technique of alcohol inactivated autograft-prosthesis composite could be able to achieve satisfactory oncological and functional outcomes in Grade III GCT.

Show MeSH

Related in: MedlinePlus

A patient with postoperative recurrence of bone giant cell tumor and pathological fracture in left distal femur (Case 4). a Osteotomy was performed at 3 cm above the upper boder of tumor, b All tissue on the tumor bone was removed and the medullary cavity was drilled through, c The tumor bone was infused in dehydrated alcohol for 30 minutes, d The deactivated autograft was adjusted and combined with prothesis using bone cement with which the bone defect filled e The autograft-prothesis composite was fixed with host bone with the junction site tied around autogenous bone as extracortical bone grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4225750&req=5

Figure 1: A patient with postoperative recurrence of bone giant cell tumor and pathological fracture in left distal femur (Case 4). a Osteotomy was performed at 3 cm above the upper boder of tumor, b All tissue on the tumor bone was removed and the medullary cavity was drilled through, c The tumor bone was infused in dehydrated alcohol for 30 minutes, d The deactivated autograft was adjusted and combined with prothesis using bone cement with which the bone defect filled e The autograft-prothesis composite was fixed with host bone with the junction site tied around autogenous bone as extracortical bone grafting.

Mentions: All patients underwent en bloc resection of tumor and reconstruction with alcohol inactivated autograft–prosthesis composite under epidural anesthesia. The domestic rotating-hinged knee prosthesis (Lidakang, Beijing, China) were chosen. The conventional anterormedial incision encircling the biopsy scar for the knee was used. A length 3 cm longer than the tumor boundary was generally accepted. The surgical technique, taking the inactivated autograft-prosthesis composite of distal femur as a sample, was described as follows: (1) The lesion in distal femur was resected according to tumor-free technique rules, and then soft tissue and extraosseous tumor were cleared off (Figure 1a). (2) The medullar cavity was reamed and intraosseous tumor was curetted with the distal femoral articular surface removed (Figure 1b). (3) Preliminary screw fixation was prepared with cemented technique. The prepared autograft was then immerged into 99% alcohol for 30 minutes, retrieved and flushed with 3000 ml physiological saline (Figure 1c). (4) After cylindrical reaming of the proximal femur, the prosthesis was inserted and cemented (Figure 1d). The long-stem femoral component was inserted into the inactivated bone off the table by carefully pressurizing cement into the inactivated bone, using the operator’s thumb to occlude the proximal medullar canal. Any excess cement was removed from the protruding stem of the femoral component and from the distal end of the inactivated bone. (5) After polymerization of the cement, the composite prosthesis was cemented into the host bone, and care was taken so no cement was caught between the inactivated autograft and the host bone. In all patients, autogenous iliac bone grafts were placed at the inactivated autograft-host bone junction to form extracortical grafting (Figure 1e).


Inactivated autograft-prosthesis composite has a role for grade III giant cell tumor of bone around the knee.

Xu S, Yu X, Xu M, Fu Z - BMC Musculoskelet Disord (2013)

A patient with postoperative recurrence of bone giant cell tumor and pathological fracture in left distal femur (Case 4). a Osteotomy was performed at 3 cm above the upper boder of tumor, b All tissue on the tumor bone was removed and the medullary cavity was drilled through, c The tumor bone was infused in dehydrated alcohol for 30 minutes, d The deactivated autograft was adjusted and combined with prothesis using bone cement with which the bone defect filled e The autograft-prothesis composite was fixed with host bone with the junction site tied around autogenous bone as extracortical bone grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225750&req=5

Figure 1: A patient with postoperative recurrence of bone giant cell tumor and pathological fracture in left distal femur (Case 4). a Osteotomy was performed at 3 cm above the upper boder of tumor, b All tissue on the tumor bone was removed and the medullary cavity was drilled through, c The tumor bone was infused in dehydrated alcohol for 30 minutes, d The deactivated autograft was adjusted and combined with prothesis using bone cement with which the bone defect filled e The autograft-prothesis composite was fixed with host bone with the junction site tied around autogenous bone as extracortical bone grafting.
Mentions: All patients underwent en bloc resection of tumor and reconstruction with alcohol inactivated autograft–prosthesis composite under epidural anesthesia. The domestic rotating-hinged knee prosthesis (Lidakang, Beijing, China) were chosen. The conventional anterormedial incision encircling the biopsy scar for the knee was used. A length 3 cm longer than the tumor boundary was generally accepted. The surgical technique, taking the inactivated autograft-prosthesis composite of distal femur as a sample, was described as follows: (1) The lesion in distal femur was resected according to tumor-free technique rules, and then soft tissue and extraosseous tumor were cleared off (Figure 1a). (2) The medullar cavity was reamed and intraosseous tumor was curetted with the distal femoral articular surface removed (Figure 1b). (3) Preliminary screw fixation was prepared with cemented technique. The prepared autograft was then immerged into 99% alcohol for 30 minutes, retrieved and flushed with 3000 ml physiological saline (Figure 1c). (4) After cylindrical reaming of the proximal femur, the prosthesis was inserted and cemented (Figure 1d). The long-stem femoral component was inserted into the inactivated bone off the table by carefully pressurizing cement into the inactivated bone, using the operator’s thumb to occlude the proximal medullar canal. Any excess cement was removed from the protruding stem of the femoral component and from the distal end of the inactivated bone. (5) After polymerization of the cement, the composite prosthesis was cemented into the host bone, and care was taken so no cement was caught between the inactivated autograft and the host bone. In all patients, autogenous iliac bone grafts were placed at the inactivated autograft-host bone junction to form extracortical grafting (Figure 1e).

Bottom Line: No recurrence, metastasis, prosthesis loosening were found.The healing time in femoral lesion is faster than that in tibial lesion.The technique of alcohol inactivated autograft-prosthesis composite could be able to achieve satisfactory oncological and functional outcomes in Grade III GCT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics, General Hospital of Ji'Nan Military Region, Ji'Nan 250031, China. yxch48@vip.sina.com.

ABSTRACT

Background: Giant cell tumors (GCT) around the knee are common and pose a special problem of reconstruction after tumor excision, especially for grade III GCT. We questioned whether en bloc resection and reconstruction with alcohol inactivated autograft-prosthesis composite would provide (1) local control and long-term survival and (2) useful limb function in patients who had grade III GCT around the knee.

Methods: We retrospectively reviewed eight patients (5 males and 3 females) treated with this procedure with mean age of 31 years (range 20 to 43 years) from Jan 2007 to Oct 2008. 5 lesions were located in distal femur and 3 in proximal tibia. 4 patients were with primary tumor and the other 4 with recurrence. 2 patients showed pathological fracture.

Results: Mean Follow-up is 54 months ranging from 38 to 47 months. No recurrence, metastasis, prosthesis loosening were found. The mean healing time between autograft and host bone was 5.5 months. The mean MSTS score was 26.3 (88%) ranging from 25 to 29. The mean ISOLS composite graft score was 32.8 (88.5%) ranging from 28 to 35. Creeping substitution is possibly the main way in bony junction. The healing time in femoral lesion is faster than that in tibial lesion.

Conclusions: The technique of alcohol inactivated autograft-prosthesis composite could be able to achieve satisfactory oncological and functional outcomes in Grade III GCT.

Show MeSH
Related in: MedlinePlus