LONG TERM FOLLOW UP OF MASSIVE OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION in BONE TUMORS
PATIENT DETAILS : CASE - 1
S.S, THAI FEMAL, 17 YEARS OLD ON 24TH JULY 1989
DIAGNOSIS : Giant Cell Tumor at Right Proximal Tibia
FIRST OPERATION: Tumor resection + replacement with osteochondral deep frozen proximal tibia allograft
DATE OF 1st SURGERY: 24TH JULY 1989
DATE OF 2nd SURGERY: 25TH JULY 2000
SECOND OPERATION: Removal of Internal Fixation and biopsy at Host-Allograft Junction
PRE-OPERATIVE X-RAY OF THE PATIENT VIEW OF THE LESION
POST -OPERATIVE X-RAY SHOWING SOME OVERHANG POST-OPERATIVE 1 YEAR 8 MONTHS
POST OPERATIVE AT 11 YEARS SHOWING GOOD BONE INCORPORATION FIXED FLEXION OF THE KNEE
POST OPERATIVE AT 11 YEARS SHOWING 1 CM SHORTNING AND FIXED FLEXION DEFORMITY DEVELOPING IN THE RT KNEE
POST OPERATIVE AT 11 YEARS SHOWING 1 CM SHORTNING AND FIXED FLEXION DEFORMITY DEVELOPING IN THE RT KNEE
PLATE AND SCREWS REMOVED AFTER 11 YEARS SPECIMEN OF HOST BONE-ALLOGRAFT WITH THE JUNCTION MARKED IN RED.
| Biopsy from articular surface of tibia. Underlying trabecular bone demonstrate lamellar bone with empty lacuna incorporate with lamellar bone that contains osteoblasts in the lacuna. The marrow space is filled by fibrovascular tissues. | Biopsy from anastamosis site demonstrates 2 layers of bony incorporation top left=viable bone, lower right= non-viable bone) | BIOPSY FROM PLATE HOLE NO 3-4 (GRAFT BONE) DEMONSTRATES CHRONIC INFLAMATORY REACTION, FIBROSIS, CALCIFICATION AND HEMOSIDERIN PIGMENT |
| BIOPSY FROM FEMORAL CONDYLE (NON-WEIGHT BEARING SITE) DEMONSTRATES DEGENERATIVE ARTICULAR CARTILAGE | BIOPSY FROM ARTICULAR SURFACE OF TIBIA. UNDERLYING TRABECULAR BONE DEMONSTRATE LAMELLAR BONE WITH EMPTY LACUNA INCORPORATE WITH LAMELLAR BONE THAT CONTAINS OSTEOBLASTS IN THE LACUNA. THE MARROW SPACE IS FILLED BY FIBROVASCULAR TISSUE. | BIOPSY FROM PLATE HOLE NO 5-6 (PATIENT BONE), DEMONSTRATE VIABLE CORTICAL BONE (OSTEOBLAST IN LACUNA) |
| BIOPSY FROM PLATE HOLE NO 3-4 (GRAFT BONE), DEMONSTRATES CHRONIC INFLAMMATORY REACTION, FIBROSIS, CALCIFICATION AND HEMOSIDERIN PIGMENT. | BIOPSY FROM PLATE HOLE NO 5-6 (PATIENT BONE), DEMONSTRATES CHRONIC INFLAMMATORY REACTION, FIBROSIS, CALCIFICATION AND HEMOSIDERIN PIGMENT | BIOPSY FROM ARTICULAR SURFACE OF TIBIA. UNDERLYING TRABECULAR BONE DEMONSTRATES LAMELLAR BONE WITH EMPTY LACUNA INCORPORATES WITH LAMELLAR BONE THAT CONTAINS OSTEOBLASTS IN THE LACUNA. THE MARROW SPACE IS FILLED BY FIBROVASCULAR TISSUE. |
DISCUSSIONS
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BONE INCORPORATION IS NOTED IN THE PHERIPHERY OF THE ALLOGRAFT AND SEEMS SLOWLY TO BE CREEPING IN THE CENTER OF THE ALLOGRAFT. |
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IMPLANT REMOVAL WAS DONE SO AS TO RELEASE THE STRESS CONCENTRATION POINTS ON THE ALLOGRAFT |
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STIFF KNEE JOINT IS NOTED |
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CARTILAGE SEEMS TO HAVE BEEN ABSORBED |
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NO PAIN OR INFECTION |
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THIS PHENOMENON COULD BE CONSIDERED AS CHARCOT JOINT ? |