Rajesh Kishanrao Ambulgekar1, Rohit Thakkar2, Rahul Berlia3, Pritesh Kothari4, Atul Shrivastava5, Saurabh Ponde6
INTRODUCTION
First described by Jaffe et al in 1940, giant cell tumour (GCT) constitutes 20% of all the skeletal neoplasms with a higher rate of recurrence after excision. Most common sites for the involvement are distal femur and proximal tibia followed by the distal end of radius. Ankle and foot involvement is rare <4%. Usually benign, they are locally aggressive and may occasionally undergo malignant transformation. The surgeon needs to strike a balance during treatment between being aggressive in order to reduce the incidence of local recurrence and being conservative in removing the normal bone to attain maximal function.
Current literature suggests that intralesional curettage strikes the best balance between controlling disease and preserving optimum function in the majority of the cases though there may be occasions where the extent of the disease mandates resection to ensure adequate disease clearance.
We report a case of Giant Cell Tumour of distal end of left Tibia in a 32-year-old female patient. Initially the condition was treated by curettage and bone grafting. But, due to recurrence of the condition within 9 months, she was treated with extended curettage using hydrogen peroxide, burr and bone cement as adjuvants and reconstruction using the “SANDWICH” Technique. At One year follow up there is no recurrence and reasonably good function around the ankle joint is maintained.
Primary Giant Cell Tumours have been traditionally treated with curettage of the lesion followed by bone grafts/bone cement. Recurrent cases often require aggressive management. The adjuvant treatment used in our case offered good stability and allowed early mobilization of the ankle joint. This case substantiates the use of bone cement in the treatment of recurrent Giant Cell Tumour of distal tibia whenever the articular integrity is intact with reasonably good functional outcomes. However, a periodic follow-up is still recommended to watch-out for late re-recurrences.
