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

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.

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.

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.

Figure 3

A patient with postoperative recurrence of bone giant cell tumor in right distal femur was treated with wide resection of tumor and replacement of alcohol-deactived autograft-prothesis composite (Case 2). (a) The preoperative X-ray image showed the osteolytic lesion encroaching articular surface and thinner cortical bone in medial condyle of right femur, (b) The preoperative CT image showed the lesion exceeding half of femoral diameter, (c-d) At 9-month after operation, the motion of right knee joint was 0°- 90°, (e) At 25-month after operation, the X-ray image showed bone healing and satisfactory space of prothesis without lossening and breakage, and the ISOLS graft score is 35.