Chennai, 5th January, 2017 – Mrs. Luxmi Manohar (49 years) was Diagnosed to have Giant cell tumor (GCT of bone are aggressive benign tumor but are potentially malignant lesions) involving her distal femur bone close to the knee joint, she was treated by curettage and cementation 16 years ago. Following which, she returned to normal life. However for the past 2 years, she developed severe knee pain associated with severe limitation of her daily activities, including climbing stairs and even walking next door. She was diagnosed with severe osteoarthritis of the knee with cement at distal end femur. In view of the complexity nature of condition, cement at distal femur with osteoarthritis, the treatment becomes very difficult.
Patient sought opinions from leading orthopedic and tumor joint replacement surgeons in middle east, UK and USA, who advised her to go in for a surgery involving removal of most of her thigh bone and replace the joint with tumor prosthesis, as routinely done around the world for Giant cell tumor followed by cementation at distal femur with osteoarthritis of knee joint. (Prostheses used in limb salvage surgeries to avoid amputations and provide restricted functionality, unlike conventional total knee replacement prostheses).. Not satisfied with the options provided abroad, she returned to her primary surgeon Dr.Nandkumar Sundaram, at ASH OMR who had operated on her for the tumor 16 years back.
After considerable planning and preparation, she was taken up for total knee replacement by Dr.Nandkumar Sundaram using conventional prostheses with navigation assistance. The procedure was successful with aid of a compact navigation system, which was used intra-operatively. The patient was able to walk the next day, climb stairs after 2 days and discharged by the 5th day.
This was the first instance in the world where regular knee replacement prosthesis with navigation assistance was used successfully in case Giant cell tumor distal femur with cementation associated with osteoarthritis.
The conventional TKR requires reaming into the femoral canal for the intramedullary jig, by doing so the chances of cement loosening and fracture at distal femur are very highly possible along with Theoretical contamination of the femoral canal by tumor activation and extension into the canal at later date. There is no need to employ tumor prosthesis in all cases as mega prosthesis surgery are more time consuming and the complication rate are very large during surgery, immediate post operatively and later complications like infection, loosening, skin necrosis with restricted mobility of the knee joint to name a few and even leading to amputation.
And by using regular knee replacement prostheses with navigation assistance in case of osteoarthritis knee joint with treated Giant cell tumor distal femur with cementation, patients are looking at a life with no restrictions or limitations and improved quality of life with ease for surgeon during surgical procedure.
