Articular Reconstruction using Subchondral Cementation and Threaded Kirschner-wires in Giant Cell Tumor: A Novel...

Giant Cell Tumor(GCT) is one of an infrequently encountered tumor by orthopaedic surgeons in clinical practice. It is described as 'locally malignant' tumor found in epimetaphyseal region of long bones, peculiarly around knee. We present a case of a solitary, benign Campanacci Grade 2 GCT in right lateral femoral condyle in 38 year old female and our treatment.

A 38 year old female presented to our outpatient department with chief complaint of constant, moderate pain in right knee increasing in duration since 3 months. No history of precedent trauma. Radiological imaging with radiographs showed suspicious lytic lesion in lateral femoral condyle. MRI scan was done.On biopsy, histopathological evaluation showed presence of characteristic multinucleated giant- cells. After confirmation, tumor en bloc resection was done, followed by chemical cauterization with 5 % phenol. Articular margins were realigned under direct vision and fixed with 1.8 mm threaded K wires. PMMA cementing in bone defect was done after achieving adequate hemostasis. At two years follow-up, patient had good result in terms of pain, knee range of motion and weight bearing.

Combination treatment of radical curettage, phenol irrigation, electrocautery and cementation is effective in preventing local recurrence. This can replace en bloc resection with a wide margin. Using subchondral threaded Kirschner wires to maintain articular margins is cheap alternative to costly implants in economically underprivileged patients.