A 40-year-old woman presented to Ujala Cygnus Brightstar Hospital, Moradabad, with persistent pain and swelling in her left knee that had progressively increased over six to eight months. The pain had become significantly worse over the preceding 15 days, leaving her unable to bear weight on her left leg. There was no history of trauma.
Clinical evaluation and imaging revealed an expansile lytic lesion at the lower end of the femur, along with a pathological fracture of the medial femoral condyle. Further investigations, including MRI and CT scans, indicated a locally aggressive Giant Cell Tumour (GCT), with the tumour extending into the surrounding soft tissues, the posteromedial region of the joint and the intercondylar area of the femur.
The extensive involvement of the knee joint made conventional reconstruction and joint preservation extremely challenging.
The Challenge: An Aggressive Tumour with Extensive Bone Destruction
Giant Cell Tumour is a locally aggressive bone tumour that commonly affects the ends of long bones, particularly around the knee. Although generally benign, it can cause significant bone destruction and has a risk of recurrence.
In this case, the tumour had extensively damaged the medial femoral condyle and intercondylar region, with further extension into the lateral femoral condyle and posteromedial joint capsule. The extent of destruction meant that preserving the natural knee joint was no longer a viable option.
The patient and her family were counselled about the nature of the tumour, its progression and the available surgical treatment options.
The Treatment: Wide Excision and Knee Reconstruction Using a Tumour Mega-Prosthesis
The surgery was performed by Dr. Indranil Halder, Consultant – Orthopaedics and Joint Replacement Surgeon at Ujala Cygnus Brightstar Hospital, Moradabad.
During surgical exploration, the team found extensive tumour involvement and gross destruction of the medial femoral condyle and intercondylar eminence. Considering the extent of the disease, the decision was made to perform a wide excision of the distal femur, removing the tumour along with approximately 2 cm of healthy bone.
Following tumour removal, the patient underwent total knee arthroplasty using a cemented distal femur-replacing tumour mega-prosthesis with a fixed-bearing hinge joint.
The reconstruction achieved a stable and functional knee joint during surgery.
The excised tissue was sent for histopathological examination, which confirmed the diagnosis of Giant Cell Tumour. The biopsy showed osteoclast-like multinucleated giant cells, characteristic of the condition.
Recovery and Rehabilitation: Early Mobility After Surgery
The patient’s postoperative recovery was encouraging, with no reported complications or wound infection. Her rehabilitation progressed as follows:
- Second postoperative day: Started walking with full weight-bearing support using a walker.
- Two weeks after surgery: Sutures were removed after complete wound healing.
- Three weeks after surgery: Started walking independently without support.
- Functional recovery: Achieved knee movement of 0–140 degrees and could climb stairs without support.
One-Year Follow-up: Stable Implant and No Evidence of Recurrence
At the one-year follow-up, the patient had a stable implant, with no clinical or radiological signs of tumour recurrence or implant loosening.
Postoperative denosumab therapy was advised, although the patient could not undergo the treatment due to financial constraints.
The Outcome
This case demonstrates how timely diagnosis, careful surgical planning and advanced reconstructive techniques can help manage locally aggressive bone tumours, even when extensive bone destruction makes joint preservation impossible.
Through wide tumour excision and reconstruction using a tumour mega-prosthesis, the patient regained independent mobility and achieved a good functional range of knee movement.
At Ujala Cygnus Hospitals, our focus remains on delivering appropriate, specialised treatment to patients and helping them move towards better health and improved quality of life.