Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Giant cell tumor of the bone (GCTB) is a benign, locally aggressive neoplasm that is relatively rare, with a propensity to result in progressive bone destruction, and is associated with a high risk of recurrence. There is no widely held consensus regarding its ideal treatment. Worldwide, there are varying techniques ranging from intralesional curettage to resection of the lesion, supplemented with combinations of numerous adjuncts and fillers, depending on the resected amount and integrity of bone, as well as the preference of the surgeon. This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals. The mean follow-up period was 37.3 months (SD=2.84). The extended curettage (EC) group had a mean Musculoskeletal Tumor Rating Scale (MSTS) score of 28.18 (SD=7.51) which is considered as an excellent outcome, while the resection (RS) group had an mean MSTS score of 19.67 (SD=11.02), which is considered as a good outcome. EC resulted to a total of eight complications (47%), while RS had one complication (33%). Prevalence of recurrence was noted to be 11.75% among those who underwent EC, while no recurrence was noted among those in the RS group. Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts, however were both were noted to result in excellent functional outcomes. Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC, there is still report of excellent functionality. It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.

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Limb Salvage Surgery in Fungating Giant Cell Tumors: A Report of Three Cases

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i02.2008 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Namith Rangaswamy ◽

Venkatesan Sampath Kumar ◽

Roshan Banjara ◽

Abdul Majeed ◽

Devansh Goyal ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Limb Salvage ◽

Salvage Surgery ◽

Cell Tumor ◽

Limb Salvage Surgery ◽

Salvage Procedure ◽

Giant Cell Tumors ◽

Distal Fibula ◽

Mesh Reconstruction

Introduction: The WHO defines giant cell tumor as a benign locally aggressive neoplasm with metastasizing capacity and aggressive behavior. Very rarely, these tumors are seen fungating, mostly when neglected. But when they do, the treatment option commonly conferred is amputation of the limb which is disabling and traumatizing. Case Report: We report three cases of fungating limb masses (proximal tibia, distal fibula, and distal radius) diagnosed with giant cell tumor histologically, undergoing limb saving surgeries with various reconstruction techniques to endorse a good quality of life and functioning limb. Conclusion: Our study is one of the earliest to report medium-term follow-up after such limb salvage procedure. We recommend that salvage procedures should be considered in giant cell tumors even in the presence of fungation if there is no neurovascular encasement. Keywords: Giant cell tumor, fungation, limb salvage surgery, endoprosthesis, mesh reconstruction.

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EKSISI DAN MEGA PROSTHESIS PADA GIANT CELL TUMOR PROXIMAL TIBIA (LAPORAN KASUS)

JURNAL ILMU KEDOKTERAN DAN KESEHATAN ◽

10.33024/jikk.v8i1.3251 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Mujaddid Idulhaq ◽

Bayu Sakti Jiwandono ◽

Ariya Maulana Nasution ◽

Handry TH

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Limb Salvage ◽

Proximal Tibia ◽

Skin Grafting ◽

Cell Tumor ◽

Limb Salvage Surgery ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Muscular Flap

Giant cell tumor (GCT) merupakan tumor destruktif tulang yang muncul di antara dekade kedua dan keempat, lokasi predileksi umumnya pada epifisis tulang panjang. Pemilihan tatalaksana operasi sangat penting dan masih menjadi perdebatan. Sebagaimana masih beragamnya pilihan tindakan pembedahan. Klasifikasi Campanacci dapat digunakan sebagai acuan untuk panduan tatalaksana. Pada kasus ini kami melaporkan seorang wanita, usia 18 tahun dengan diagnosa giant cell tumor pada proximal tibia dextra dengan Campanacci grade III. Pasien telah menjalani operasi limb salvage tahap pertama berupa eksisi luas pada proximal tibia dextra dan knee arthrodesis. Setelah 4 bulan dilakukan operasi limb salvage tahap kedua yaitu knee arthroplasty dengan megaprosthesis. Untuk mencegah komplikasi implant expose, dilakukan muscular flap dan split thickness skin grafting (STSG). Setelah dilakukan evaluasi selama 4 bulan, klinis pasien baik, pasien dapat berjalan alat bantu dan tanpa nyeri, tidak ada komplikasi pada luka operasi dan fiksasi implan baik. Kesimpulan yang didapatkan bahwa limb salvage surgery pada giant cell tumor proximal tibia dapat dilakukan dengan tindakan rekonstruksi dua tahap. Teknik muscular flap dan split thickness skin grafting (STSG) dapat digunakan untuk mencegah terjadinya implant expose.

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GIANT CELL TUMOR OF THE RIGHT DISTAL FEMUR REGION IN A MALE 25 YEARS OLD WITH HIV POSITIVE (RARE CASE)

Biomedika ◽

10.23917/biomedika.v11i2.8279 ◽

2019 ◽

Vol 11 (2) ◽

pp. 90-95

Author(s):

Muhammad Riyadli ◽

Mujaddid Idulhaq ◽

Pamudji Utomo

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Limb Salvage ◽

Distal Femur ◽

Cell Tumor ◽

Wide Excision ◽

Hiv Positive ◽

Limb Salvage Surgery ◽

Knee Arthrodesis ◽

The Right

Giant cell tumor (GCT) with Human Immunodeficiency Virus (HIV) infection is a rare case. At present, few literatures reported about GCT with HIV positive patients and there are no effective treatments of this disease currently. The aim of this article is to report the change the surgical treatment from limb salvage (wide excision and endoprostheses) to another way limb salvage (wide excision and knee arthrodesis) to minimize risk and further complication. A case of male, 25 years old, with diagnosis GCT of the right distal femur with HIV positive. In this case we administered antiretroviral treatment (ARV) and planned to limb salvage surgery (wide excision and knee arthrodesis).We follow up this patient in the first 4 weeks. There were no complaints, good postoperative wounds, no signs of infection, and histopathological examination postoperative showed the positive results of a GCT. The conclusion the surgical treatment from limb salvage (wide excision and endoprostheses) to another way limb salvage (wide excision and knee arthrodesis) could minimize risk and further complication.Keywords: Giant Cell Tumor, HIV,Limb Salvage Surgery, Wide Excision, Arthrodesis KneeGiant Cell Tumor (GCT) disertai dengan infeksi Human Imminodeficiency Virus (HIV) merupakan kasus yang jarang terjadi. Pada saat ini hanya sedikit literatur yang melaporkan kejadian pasien GCT dengan HIV positif dan belum ada standar terapi yang efektif. Tujuan dari artikel ini adalah melaporkan penggantian penatalaksanaan operatif sebelumnya berupa limb salvage (eksisi luas dan pemasangan endoprosthesis) menjadi eksisi luas dan arthrodesis knee untuk meminimalisir risiko dan kompikasi lebih lanjut. Kasus seorang laki-laki usia 25 tahun dengan diagnosis GCT pada distal femur kanan dengan infeksi HIV positif. Pada kasus ini, terapi yang diberikan adalah Anti Retroviral (ARV) dan operatif dengan limb salvage (eksisi luas dan arthrodesis lutut). Follow up pasien ini pada 4 minggu pertama post operasi. Keluhan nyeri berkurang, luka operasi baik, tidak ada tanda infeksi dan pemeriksaan histopatologi menunjukkan hasil GCT.Kesimpulannya bahwa penatalaksanaan operatif sebelumnya berupa limb salvage (eksisi luas dan pemasangan endoprosthesis) menjadi eksisi luas dan arthrodesis knee dapat meminimalisir risiko dan kompikasi lebih lanjut. Kata Kunci: Giant Cell Tumor, Hiv, Limb Salvage, Eksisiluas, Arthrodesis Lutut

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Clinical and Functional Outcomes using the Kyocera Modular Limb Salvage System for Lower Extremity Reconstruction

10.21203/rs.3.rs-37321/v1 ◽

2020 ◽

Author(s):

Donnel Alexis Ting Rubio ◽

Katsuhiro Hayashi ◽

Norio Yamamoto ◽

Toshiharu Shirai ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Aseptic Loosening ◽

Limb Salvage ◽

Functional Outcomes ◽

Salvage Surgery ◽

Valgus Deformity ◽

Limb Salvage Surgery ◽

Superficial Infection ◽

Prosthesis Survival ◽

Tumor Group

Abstract Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.

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Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684972 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668497 ◽

Cited By ~ 6

Author(s):

Abhijeet Ashok Salunke ◽

Jaymin Shah ◽

Vikas Warikoo ◽

Amit Chakraborty ◽

Harshwardhan Pokharkar ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Functional Outcomes ◽

Soft Tissues ◽

Cell Tumor ◽

Musculoskeletal Tumor Society ◽

Wrist Arthrodesis ◽

The Mean

Introduction: The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. Methods: Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. Result: Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12–36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22–28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5–8) months and ulna to carpal junction at 4.5 (4–6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). Conclusion: Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.

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Giant Cell Tumor on Tendon Sheath of the Hand: The Incidence of Recurrence, Functional Outcomes and a Literature Review

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol05-i12/1024 ◽

2020 ◽

Vol 5 (12) ◽

pp. 638-644

Author(s):

Kastanis G ◽

Bachlitzanaki M ◽

Kapsetakis P ◽

Christoforidis C ◽

Chaniotakis C ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Functional Outcomes ◽

Hand Function ◽

Tendon Sheath ◽

Cell Tumor ◽

Dash Score ◽

A2 Pulley ◽

Quick Dash

Giant Cell Tumor on Tendon Sheath (GCTTS) of the hand is a benign nodular tumor originated from tendon sheath of the tendons and the joints and is the second most common soft tissue tumor of the hand after ganglion cyst. The aim of this study is to evaluate 79 cases of giant cell tumor of tendon sheath of the hand and to analyze the postoperative functional outcomes and recurrence rate of the tumor in a mean period of five years follow up. Material and Methods: Fifty five subjects were females and twenty four males with an average age of 38,8 years-old (range23-65 years old) were included in this study. The most frequent location of tumor was the index finger (32/79 patients, 40,5%). The majority of patients was presented in outpatient’s clinic for a painless swelling on volar side of the digit, while only 13(16,45%) patients presented for painful mass and numbness of the digit in 7(8,9%) cases. All cases were categorized by Al-Qattan classification system with type I lesion in 51(64,5 %) cases and type II in 28(35,5 %) cases. Dimension of tumors macroscopically varied from 0,4cm to 5 cm. In 12 cases we reconstructed the A2 pulley to avoid bowstring deformity and eventual postoperative loss of hand function. In 12 cases we reconstructed the A2 pulley to avoid bowstring deformity and eventual postoperative loss of hand function. 8 patents with bone erosion underwent postoperatively complementary local radiotherapy. A standard protocol of rehabilitation was performed in all patients. Results: Results were evaluated according to complications, range of motion, Quick Dash Score and functional satisfaction of patients in a mean follow-up of 49 months. Two major complications presented in this study: 5 cases with transitional neuroapraxia and 6 cases with recurrence of the tumor with a mean of postsurgical period 14,8 months. Finally at last assessment the mean Quick Dash Score was 4,5 (range from 0-11,4) the range of motion was fully recovered in 73 patients while patient’s satisfaction rated from “very satisfied” in 58(73,4%) cases, “satisfied” in 17(21,5) and “dissatisfied” in 4(5,1%) patients. Conclusions: Giant cell tumor of tendon sheath of the hand is a common tumor which presents a high incidence of recurrence in different populations of patients. The goal of treatment is to reduce the recurrence rate and restore a functional hand. The operation procedure should be well planned preoperatively, the tumor must excised en block, dissection must be under surgical loop and must be emphasized to remove satellite lesion while when patients present increased risk factors or inadequate excision of the mass, postoperative radiotherapy is performed.

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Giant cell tumor of the fifth lumbar vertebra with a three-year follow-up: case report and review of the literature

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-0976-1 ◽

2012 ◽

Vol 22 (S1) ◽

pp. 15-19

Author(s):

Michael Athanassacopoulos ◽

Georgios K. Triantafyllopoulos ◽

Spyridon G. Pneumaticos

Keyword(s):

Case Report ◽

Giant Cell Tumor ◽

Giant Cell ◽

Lumbar Vertebra ◽

Cell Tumor ◽

Review Of The Literature ◽

Fifth Lumbar Vertebra

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Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽

10.1080/13577149878118 ◽

1998 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 20

Author(s):

Rikke Johansen ◽

Ole S. Nielsen ◽

Johnny Keller

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Univariate Analysis ◽

Soft Tissue Sarcomas ◽

Post Treatment ◽

Limb Salvage Surgery ◽

Functional Evaluation ◽

Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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