Modular endoprosthetics proximal tibia in case of giant cell tumor

Abstract

Surgical treatment of a giant cell tumor (GCT) remains a complex and urgent problem. Its tactics depend on the size and location of GCT. Age of the patient, the presence of pathological fractures, invasion of blood vessels and nerves.Objective: to study the results of modular Endoprosthetics of the proximal tibial (PT) in case of a GCT injury.Methods: the study group included 16 patients (9 women, 7 men, age from 18 to 56 years) with GCT of PT (stage III according to the classification of Enneking). Patients were examined according to generally accepted methods, X-rays, CT scans (if angio CT was necessary), and Biopsy were performed. Surgical treatment: resection of PT with GCT «en block», modular endoprosthetics recostruction with the MUTARS Implant cast system (6 patients), CИMEКС (9) and GMRS Stryker (1), soft tissue reinsertion to the endoprosthesis body, knee-joint extension plastic. The capsule of the suspension and the patella bundles were fixed on an Attachment tube (СИМЕКС and MUTARS systems) or using a nylon ribbon (GMRS Stryker). For the evaluation used the scale MSTS and TESS.Results: patients returned to normal life on average 2–2.5 months. The functional results on the MSTS scale were (72 ± 12) %, on the TESS scale — (74 ± 16) % and were classified as good. During the observation period of 6 months. up to 14 years not a single tumor recurrence was detected.Results: 2 (12.5 %) — periprosthetic infection, 1 (6.2 %) — traumatic damage to the extensor apparatus.Conclusions: resection of «en blok» in the case of Enneking stage III GCT made it possible to avoid oncological complications during the observation period up to 14 years. The use of modular endoprostheses, the reinstallation of soft tissues on the body of the endoprosthesis and the plastic of the extension apparatus of the knee joint, the early activation of the patient contributed to the achievement of a good functional result.