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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.

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Related in: MedlinePlus

A patient with postoperative recurrence of GCT in right proximal tibia (Case 6). a Preoperative CT image showed the diameter of GCT lesion with soft tissue mass was over 1/2 on CT transversal image, b Extracortical grafting and medial gastrocnemius muscle flap transfer should be noted during operation, c Destruction of bone was shown on preoperative X-ray image, d After one week, good position of autograft-prosthesis composite was shown, e Bone callus was obvious 6 weeks after operation, f Osteotomy line dismissed and bone healing was found after 1 year. g After 3 years, the autograft-composite was in good position. MSTS score was 29 and ISOLS score was 35.
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Figure 2: A patient with postoperative recurrence of GCT in right proximal tibia (Case 6). a Preoperative CT image showed the diameter of GCT lesion with soft tissue mass was over 1/2 on CT transversal image, b Extracortical grafting and medial gastrocnemius muscle flap transfer should be noted during operation, c Destruction of bone was shown on preoperative X-ray image, d After one week, good position of autograft-prosthesis composite was shown, e Bone callus was obvious 6 weeks after operation, f Osteotomy line dismissed and bone healing was found after 1 year. g After 3 years, the autograft-composite was in good position. MSTS score was 29 and ISOLS score was 35.

Mentions: For GCT in proximal tibia, we think it was important to use the medial gastrocnemius muscle flap transfer to minimize the rate of complication, such as infection and skin necrosis (Figure 2b). The patellar tendon was sutured directly to the transposed flap to repair the extensor mechanism. The continuity of intact side of tumor bone with pathological fracture should be maintained during the inactivation procedure. The larger bone fragments should be cemented to inactivated tumor after alcohol inactivation.


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 GCT in right proximal tibia (Case 6). a Preoperative CT image showed the diameter of GCT lesion with soft tissue mass was over 1/2 on CT transversal image, b Extracortical grafting and medial gastrocnemius muscle flap transfer should be noted during operation, c Destruction of bone was shown on preoperative X-ray image, d After one week, good position of autograft-prosthesis composite was shown, e Bone callus was obvious 6 weeks after operation, f Osteotomy line dismissed and bone healing was found after 1 year. g After 3 years, the autograft-composite was in good position. MSTS score was 29 and ISOLS score was 35.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A patient with postoperative recurrence of GCT in right proximal tibia (Case 6). a Preoperative CT image showed the diameter of GCT lesion with soft tissue mass was over 1/2 on CT transversal image, b Extracortical grafting and medial gastrocnemius muscle flap transfer should be noted during operation, c Destruction of bone was shown on preoperative X-ray image, d After one week, good position of autograft-prosthesis composite was shown, e Bone callus was obvious 6 weeks after operation, f Osteotomy line dismissed and bone healing was found after 1 year. g After 3 years, the autograft-composite was in good position. MSTS score was 29 and ISOLS score was 35.
Mentions: For GCT in proximal tibia, we think it was important to use the medial gastrocnemius muscle flap transfer to minimize the rate of complication, such as infection and skin necrosis (Figure 2b). The patellar tendon was sutured directly to the transposed flap to repair the extensor mechanism. The continuity of intact side of tumor bone with pathological fracture should be maintained during the inactivation procedure. The larger bone fragments should be cemented to inactivated tumor after alcohol inactivation.

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