Gct lower end femur

GCT lower end femurCementing1997 - 2016

Vinod NaneriaGirish Yeotikar

Arjun WadhwaniChoithram Hospital & Research Centre,

Indore, India.

Purpose of Presentation

• Long term effect of subchondral cement in development of early cartilage damage & Osteoarthritis.

• Cement fracture in the absence of metal support.• Development of sarcomatous changes due to

Radiation therapy.• Long term effect on functional status of knee

joint.

Case history

• A 20 yrs old female, GCT lower end femur lt.• Curetting & grafting with Cementing done 1997• Pathological fracture treated conservatively.• Recurrence – 1998• Radiation followed by repeat curettage and

cementing -1998.• Yearly follow up till Jan.2016

Pathological fracture – 1998Treated conservatively

Repeat curettage + Cementing + Radiation1999

Follow up 2000

Follow up 2006

Follow up 2009

MRI for Cartilage damage 2009

MRI for Cartilage damage 2009

MRI for Cartilage damage 2009

Follow up 2013

Piece of cement separation

Follow up 2015

Follow up 2015

Occasional cyst formation

Case summary

• Follow up from Sept 1997 – January 2016.• Functionally normal – full ROM and squating.• A small piece of cement is lying loose in

posterior – medial soft tissue.• A small fluid collection occurs medially from

the site of cement avulsion occasionally.• Planning to remove the loose piece.

comments

• We did not find any deterioration in function of knee in spite of repeated squatting and sitting cross legged position.

• Repeated MRI were done to assess early development of Cartilage damage and any sarcomatous changes in the lesion.

• A small piece of cement avulsed from adductor tubercle region and is loose in posterior and medial soft tissue.

comments

• There is off and on formation of small cyst at the site of avulsion of cement.

• We did not observed any fracture in cement mantle, though three packets of cements were used.

• However there is always a question mark on proper management of secondary OA or Sarcoma if developed, as patient is too young for Maga-prosthesis and there is no bone for fusion of knee.

DISCLAIMER • Information contained and transmitted by this presentation is based

on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India.

• It is intended for use only by the students of orthopaedic surgery. • Views and opinion expressed in this presentation are personal. • Depending upon the x-rays and clinical presentations viewers can

make their own opinion. • For any confusion please contact the sole author for clarification.• Every body is allowed to copy or download and use the material best

suited to him. • We not responsible for any controversies arise out of this

presentation. For any correction or suggestion please contact naneria@yahoo.com