Challenging Knee Reconstruction After Resection of Cavernous Hemangioma in Young Patient – A case Report

Abstract

Background:One of the most challenging problem of limb salvage is a large tumour involving knee joint. Large aggressive hemangioma could disrupt soft tissue and bone surrounding. Meticulous wide surgical resection was mandatory perfomed to ensure adequate resection in order to minimized recurrence. Reconstructive procedure should be individualized and aiming functional restoration. Knee Reconstruction using arthroplasty should considered Stability, Range of Motion and Longlive survival.Method:We are presenting a case 19 years girl who had pain, unable to extent the knee and dislocated patella laterally. Valgus knee deformity 30 ֯ with Range of motion limited extension 30֯ and flexion 45֯ Wide resection was done 2 years ago with clinical large of mass at harmstring muscle, pushed patella to lateral and large of cartilage erosions. The patients was prepared second operation for knee reconstruction. Knee reconstruction using standard Posterior Stabilized implant (Implancast) Approach anterior of knee, osteotomy and anteromedialisation tibial tubercle ( Fulkerson procedure) with lateral retincular release to restore patellar tracking. Exposing Joint line very narrow and fully filled with arthrofibrosis, was identified and did osteotomy . Mostly femoral and tibial cartilage has been damaged. Post operation protocol using long leg cast and delayed weight bearing for 3 weeks. Isometric exercise on the bed to maintance and regain muscle power. During 3 – 6 weeks cast was removed and patient was allowed to partial weight bearing using 2 crutches. Extensor muscle strengthening was performed gradually. Followed up until 6 months post operation.Results:After 6 months we evaluate no pain at full weight bearing, x ray no sign of loosening nor progressive deformity, good stability with varus valgus test. Range of motion full extension and 90֯ flexion. Knee Society Score was significantly increase from poor to good.Conclusion:Knee Reconstruction following tumor resection using standard implant Posterior Stabilized (PS) is possible to perfomed as long as using meticulous technique combined with selective procedures as needed to regain functional restoration.