Custom Mega Prosthetic Reconstruction of distal femoral malignant giant cell tumor - A case report.

Abstract

Giant cell tumours (GCT) are benign to aggressive lesions which are frequently encountered in orthopaedic  practice. They represent 3-4 of all primary tumors of bone, occurring in young healthy adults in the third and fourth decade of life. The ends of long bones in skeletally mature individuals are involved in more than 80 of cases and 75 of them occur around the knee joint. Eighty per cent of the GCT have a benign course, with a local recurrence rate of 10-50 about 10 of GCT undergo malignant transformation through their recurrences and 1-4 give pulmonary metastases even in case of a benign histology. For last two decades, there is technical advances in surgical management of GCTs with introduction of new techniques and improvising of the existing techniques. There is a universal consensus in favour of  extended curettage with or without adjuvants even in   recurrent cases. Current evidence suggested that curettage alone in cysts of 60 cm3 (about 5 cm in diameter) yielded satisfactory results, and lesions greater than this carry a very high risk of pathological fracture or late development of        osteoarthritis and a filler is essential1. Also lesions in which more than 23rd of the cortex of the bone is destroyed in a single view, prophylactic fixation is adviced2. We consider worthwhile reporting a case of distal femoral aggressive GCT in 28 years old female, treated by wide excision and   reconstruction with custom mega prosthesis with good  functional outcome.