The Patient aged 49 years was diagnosed to have Giant cell tumour 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, her treatment options became very difficult.
Patient sought opinions from leading orthopaedic and tumour 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 tumour prosthesis, as routinely done around the world for Giant cell tumor followed by cementation at distal femur with osteoarthritis of knee joint. Not satisfied with the options provided abroad, she returned to her primary surgeon Dr.Nandkumar Sundaram, at Apollo Specialty Hospitals, OMR, Chennai who had operated on her for the tumour 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 is the first instance in the world where regular knee replacement prosthesis with navigation assistance was used successfully in case Giant cell tumour distal femur with cementation associated with osteoarthritis.
The conventional Total Knee Replacement requires reaming into the femoral canal for the intramedullary jig and by doing so the chances of cement loosening and fracture at distal femur are highly possible along with theoretical contamination of the femoral canal by tumor activation and extension into the canal at later date.
By adopting 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.
