1/3. A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.OBJECTIVE: Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. PATIENT AND methods: We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. RESULTS: Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. CONCLUSIONS: Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/3. Giant cell tumor of the distal fibula: fifteen-year result after en bloc resection and fibula reconstruction.INTRODUCTION: Giant cell tumor of the distal fibula is a very rare condition. The treatment of advanced tumors at this location can be challenging and has been described in the literature only in single cases. MATERIALS AND methods: We report on a patient with a stage III giant cell tumor, according to the classification of Campanacci, of the distal fibula after en bloc resection and distal fibula reconstruction with a long bone graft from the iliac crest in a second procedure. The syndesmosis was reconstructed with a periosteal flap, the capsule and ligaments with local scar tissue. RESULTS: Fifteen years after the initial treatment the patient is free of local recurrence and demonstrates an excellent clinical outcome without any signs of instability, loss of function or osteoarthritis of the ankle joint. CONCLUSION: We suggest the method to be worthwhile for treatment of this uncommon lesion in terms of recurrence and functional outcome.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/3. Malignant giant cell tumour of the distal femur treated by excision, allografting and ligamentous reconstruction: an 18-year follow-up.Extensive osteoarticular allografts have been used for knee reconstruction, but because of their composite nature and the technical difficulty of the procedure, complication and failure rates have been high. There are few records of long-term results in the literature. In this report, a 19-year-old man with a large aggressive giant cell tumour of the left distal femur was treated in 1976 by en bloc resection, massive femoral allografting and ligamentous reconstruction. Follow-up after 18 years showed no recurrence of the tumour, excellent incorporation of the graft and good knee function, which allowed the patient to work 9 hours a day on his feet without pain.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |