Management of a Giant Cell tumors with megaprosthesis in a resource-limited setting

Abstract

Giant Cell Tumors (GCTs) of bone are primary bone tumors that are benign. They are biologically aggressive and have metastatic potential after malignant transformation. There have been several cases of GCTs described in the medical literature. The management of juxta-articular GCTs in the young population is one of the greatest challenges in orthopaedic oncology. Amputations were once the standard treatment for malignant bone tumours. Advances in orthopaedic surgical techniques and bioengineering have made limb-sparing surgery a viable treatment option. Limb- salvage surgery is considered safe and is routinely undertaken for 90% of cases of bone tumors. The advances in orthopaedic surgical techniques and bioengineering of prosthesis have made this a viable option for these complex cases.Staging is performed using the Campanacci Radiographic Classification System and this is based on the radiological findings of the GCT. This staging system is used to guide the planning of the initial surgical management. Campanacci Stage III GCTs are aggressive lesions thus En bloc resection and reconstruction have been proposed as the choice of treatment. This is done with the goal of joint preservation as well as reducing the risk of recurrence. This case report highlights the challenges in the management of a Campanacci Grade III GCT of the distal femur. A mega prosthesis or endoprosthesis is a viable first-line treatment for oncological patients with significant bone and soft tissue loss. Oncological clearance was achieved then by the customized megaprosthesis was assembled and set in place. Procurement of this custom-made megaprosthesis during the COVID-19 pandemic was particularly challenging.