Dr. Pradeep Sharma
Director & Head
BLK Centre for Orthopaedics
Joint Reconstruction
& Spine Surgery
BLK Super Speciality
Hospital, New Delhi

Dr. Rajesh Verma
Consultant

Dr. Akshat Sharma
Associate Consultant

BLK Centre for Orthopaedics
Joint Reconstruction
& Spine Surgery
BLK Super Speciality
Hospital, New Delhi

THE CASE

A 46-year old lady from Iraq visited BLK Centre For Orthopaedics, Joint Reconstruction & Spine Surgery with complaints of swelling and pain over her right lower thigh and knee joint. The patient had a previous history of giant cell Tumour of right distal femur, which was treated by curettage, bone grafting and screw fixation 3 years ago. On examination, two longitudinal surgical scars were present over anterior and medial aspect of the knee. The distal thigh and knee showed diffuse swelling. Tenderness, thickening and irregularity of the distal femur were appreciated. Plain radiographs showed multiple areas of lyses in the previously treated lesion. MRI was suggestive of recurrent lesion measuring 34 mm × 32 mm × 19 mm with no evidence of cortical breach, soft tissue or knee joint involvement.

THE PROCEDURE

Wide resection of the Tumour and reconstruction of the lower end of femur using Stryker Tumour Prosthesis was planned with surgical oncology team of BLK Cancer Centre.

Tumour resection with excision of distal femur 12 cm from the knee joint was undertaken by surgical oncology team using medial approach to distal femur and knee. Neurovascular structures were exposed and protected. Bone marrow from proximal extent of resection was sent for frozen section and a negative tumour margin was confirmed. The knee joint was reconstructed using Stryker Tumour Prosthesis. The femoral canal was prepared and SM distal femur implant with 11 mm curved stem with 50 mm extension was inserted. Cemented SM-1 tibial base plate was inserted, and the knee reduced over a 13 mm polyethylene insert.

THE RESULT

Post-operative period was uneventful. The patient was mobilised on second post-operative day with partial weight bearing, with knee in extension, to allow for adequate soft tissue healing. She was discharged from the hospital with a painless, mobile and stable knee joint.

DISCUSSION

The Tumour Prosthesis used in this case offers the surgeon, the possibility of large defects in the distal femur using extension stems. The hinged knee compensates for the excision of the collateral and cruciate ligaments of the knee, attempting to reproduce physiological femoro-tibial and patellar kinematics. The wide range of movement and stability afforded has made reconstruction following extensive Tumour resection a successful management option.