Resection and arthrodesis of the knee joint for giant cell tumours of bone.

PURPOSE

To evaluate functional outcomes and complications following resection and arthrodesis of the knee for giant cell tumours (GCTs) of bone, in comparison to treatment by endoprosthetic replacements reported elsewhere.

METHODS

18 men and 14 women aged 18 to 40 (mean, 28) years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur (n=17) and proximal tibia (n=15). After wide resection, 2 struts were fashioned from the harvested fibula/ fibulae and inserted into the medullary canal at the resected ends of the tibia and femur. The corresponding ends of the struts were inserted into peg holes made in the unaffected condyles in a divergent fashion. The knee was arthrodesed in 5 to 10 degrees of flexion, with the limb kept 1 cm short. A 95-degree AO condylar bladeplate (10-12 holes) was fixed at the resected ends, with a minimum of 8 cortices purchase. Cancellous bone grafts were placed transversely along the struts and circumferentially over the host-graft junctions. Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere.

RESULTS

Patients were followed up for a mean of 8 (range, 3-12) years. The mean size of the tumours was 10x8x6 cm. All patients achieved arthrodesis and full weight bearing without pain within 6 to 10 (mean, 6) months. No shortening, loss of alignment, loosening, implant breakage ensued. One patient had a deep infection and absorption at the host-graft junction. Another had a stress fracture of the fibular strut after plate removal. Two patients had a transient peroneal nerve palsy. One patient had local recurrence and extensive fungation and underwent amputation. The mean functional score was 26 (87% of the full score), compared to 66 to 85% in endoprosthetic arthroplasty reported elsewhere.

CONCLUSION

Arthrodesis is a viable alternative to customised arthroplasty and provides a long-lasting and cost-effective reconstruction for average patients in developing countries.