Natarajan Mayil Vahanan, Prabhakar R, Mohamed Sameer M, Shashidhar Ra
Department of Orthopedic Surgery, Madras Medical College and Govt. General Hospital, Chennai - 600 003, India.
Indian J Orthop. 2007 Apr;41(2):134-8. doi: 10.4103/0019-5413.32045.
Juxtaarticular giant cell tumors around the knee are common and pose a special problem of reconstruction after tumor excision. This article analyzes the functional outcome after resection of juxtaarticular giant cell tumors around the knee and replacement by custom mega prosthetic arthroplasty.
One hundred and forty-three patients with juxtaarticular giant cell tumors around the knee with mean age of 30.8 years (range 15 to 64 years) underwent resection and replacement by custom mega prosthetic arthroplasty during the period 1994 to 2005. Eighty-one patients were males and 62 were females. Fourteen patients were in Enneking Stage 2 while 129 patients were in Stage 3. Distal femur was involved in 87 patients and proximal tibia in 56 patients. Forty patients presented with pathological fracture at the time of diagnosis. The technique of sleeve resection of the quadriceps musculature was followed to achieve local clearance in distal femoral tumors, and for proximal tibial lesions resection of the tumor-bearing part and a medial gastronemius rotation flap was used routinely. The prosthesis used was a rotating hinge custom mega prosthesis manufactured locally.
The mean follow-up was 5.4 years (1.5 years to 11 years). Functional results were analyzed using Enneking criteria. Excellent results were obtained in 90 patients (62%) and 39 patients had good (27%) results. Periprosthetic fracture (8.3%) and infection (6.9%) were the most common complications followed by aseptic loosening (4.2%). Recurrence of lesion was found in only one patient (0.69%) who was managed with wide local excision.
Custom mega prosthetic arthroplasty is effective in achieving the desired goals of reconstruction with good functional results and least complications in selected patients.
膝关节周围的近关节巨细胞瘤很常见，并且在肿瘤切除后带来了特殊的重建问题。本文分析了膝关节周围近关节巨细胞瘤切除并用定制大型假体置换后的功能结果。
1994年至2005年期间，143例膝关节周围近关节巨细胞瘤患者接受了切除并用定制大型假体置换，平均年龄为30.8岁（范围15至64岁）。81例为男性，62例为女性。14例患者处于Enneking 2期，129例患者处于3期。87例患者累及股骨远端，56例患者累及胫骨近端。40例患者在诊断时出现病理性骨折。对于股骨远端肿瘤，采用股四头肌袖状切除技术以实现局部清除，对于胫骨近端病变，常规采用切除肿瘤所在部分并使用内侧腓肠肌旋转皮瓣。使用的假体是本地制造的旋转铰链定制大型假体。
平均随访时间为5.4年（1.5年至11年）。使用Enneking标准分析功能结果。90例患者（62%）获得了优异结果，39例患者（27%）获得了良好结果。假体周围骨折（8.3%）和感染（6.9%）是最常见的并发症，其次是无菌性松动（4.2%）。仅1例患者（0.69%）出现病变复发，经广泛局部切除处理。
定制大型假体置换术在选定患者中有效地实现了重建的预期目标，功能结果良好且并发症最少。
