Long-term results of condylar reconstruction using pedicled-patella in the treatment of giant cell tumor of bone of lower femur / 中华骨科杂志

ABSTRACT

Objective To study the long term results of condylar reconstruction using pedicled patella in the treatment of giant cell tumor of lower femur. Methods From August 1964 to December 1996, 6 patients with giant cell tumor in the lateral condyle of femur were treated with unicondylar resection curettage and reconstruction with pedicled patella autograft. There were 3 males and 3 females. The average age of the pateints was 30.5 years. The operative indications were as the following: tumor was located in one condyle, complicated with pathological fracture or the tumor had invaded underneath cartilage which was difficult for curettage. Surgical procedure included: Lateral condyle resection according to X ray or CT image, curettage of the possible remaining tumor tissues in the medial condyle. A muscle pedicle of 2.5 cm wide from the quadriceps was raised with the patella, then the articular surface of patella was used to reconstruct the articular surface of femoral condyle, ilium graft(sometimes allograft) was used to fill the defect proximal to the patella. The grafts was fixed by screws and(or) plates. Anterior cross ligament was fixed to the patella. Results 6 patients were followed up for a mean period of 136 months. There were no infection, recurrence, metastasis and instability. All patients could walk for a long distance. The range of motion of the involved knees was between 80? and 120?. There was no varus deformity under stress test, but about 5 degrees valgus deformity under stress test could be found in some, muscle strenth was 5 grade. Conclusion Pedicled patella autograft is a good method for the treatment of giant cell tumor that invades unilateral condyle of lower femur, it is specially suitable to the patients with pathological fracture or severe destruction underneath the cartilage. Thorough resection and curretage of the tumor, preserving the blood supply of patella, refixing the cross ligament, and lower placement of patella are the key points to obtain the satisfactory results.