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
Reconstruction of recurrence in giant cell Tumour of
distal femur with Tumour Prosthesis
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.