Limb Salvage Procedure in Giant Cell Tumors Around the Knee Joint by Enbloc Excision of Bone & Simultaneous Bone Lengthening by Ilizarov Method

Background: Enbloc excision of bone in Giant Cell Tumor (GCT) around the knee joint leaves a bone defect which requires a complex reconstructive procedure. The present study analyzes limb salvage procedures by enbloc excision of bone and bone lengthening by Ilizarov method, in terms of various complications and morbidity encountered. Materials and Methods: Ten cases (M-six and F-four; lower end femur three and upper end tibia - seven) of Giant Cell Tumor around the knee joint, stage 3 tumours were included. Mean age was 24.8 years (range 18-32 years). Enbloc excision of the femoral and tibial condyles and bone transportation by Ilizarov technique by distal tibial corticotomy and later on knee arthodesis was performed in all the cases. Results: Shortening was the major problem following enbloc excision and subsequent limb lengthening. Infection occurred only in one case and required multiple drainage procedures. After enbloc excision, the resultant gap (mean ~15cm) was managed with simultaneous limb lengthening with a distal tibial corticotomy on an Ilizarov fixator. The complications were skin and soft tissue impingement between the proximal and distal fragment (n=4) and distortion of the ankle mortis due to proximal transportation of the distal end of ulna (n=1). The usual time taken for union and limb length equalization was approximately one and half years. Conclusion: Enbloc excision of bone and simultaneous bone lengthening by Ilizarov method achieved limb length equalization with relatively short morbidity.