COMBINATION TREATMENT OF LOWER LIMB GIANT CELL TUMOURS USING PMA CEMENT AND A LOCKING PLATE

Abstract

Giant cell tumours of bone involving the lower limb are characteristically close to the knee joint and pose a challenge in their treatment with respect to functional outcome, risk of recurrence and complications. Various treatment modalities exist, but it is widely accepted that intra-lesional curettage followed by local adjuvants and cementation of the defect may protect the integrity of the nearby joint and maintain function and stability.

Many studies have reported on the use of various adjuvants and different methods of filling the defect left by intralesional curettage as well as fixation of impending or simultaneous pathological fractures with plate and screws. Up to 12 weeks, or more, of non weight bearing has been advised post-op, particularly in the larger lesions.

We have encountered no evidence of the use of locking plates in augmenting reconstruction with PMA bone cement, particularly when a large lesion, displaying a very thin cortical envelope is encountered, and where there may be concern for knee strength and stability post-op. We surmised that the addition of such a rigid construct would be of benefit in aiding a faster rehabilitation.

At our institution we have treated 3 patients in this manner: two patients had large giant cell tumours of the proximal tibia and one involving the distal femur. They were treated with intralesional curettage, liquid nitrogen, and bone cementation but in all three cases, we augmented the cement filler with a locking plate.

Although we have a limited sample size, and our mean follow-up is only 12 months, it has been our experience that this approach may provide an immediately stable knee, rapid rehabilitation with return to full weight bearing within 4–6 weeks and very good post-operative function by 3 months post-op, with few complications.