50 years old lady having severe knee pain which gradually increased over three months and now unable to bear weight or walk on right lower limb. She has severe tenderness over distal thigh region and painful restricted knee movements without neurovascular problems.
She was investigated which revealed large lytic lesion in distal femoral condyle on xray and malignant invasion of distal femoral condyles with breach in posterior cortex and medullary involvement. Further investigations reveal no metastasis anywhere in body. Biopsy through cortical window revealed unusal and rare high grade spindle cell sarcoma in distal femur.
She was given option of limb reconstruction surgery to save limb. She underwent surgery through anteromedial knee arthrotomy approach with poplieal vessels isolation. Complete tumor excision with soft tissue envelope and wide local excision of distal f emur done. Defect in distal femur shaft and condyle was fixed with femur replacing endoprosthesis by Restore system and total knee replacement was done. Knee stability and mobility confirmed and full range of movements achieved.
Postoperative she was ambulated full weight bearing immediately, started walking with support and knee physiotherapy was started. Her wounds healed completely, was painfree with full range of movements and able to walk independently at six weeks follow up. Post excision biopsy suggest sarcoma with no tumor tissue at margins.
Patient has a very high satisfaction in terms of pain and mobility with this surgery and will have a good survival rate and doing all activities of daily living. Such endoprosthetic availability and surgery saves lot of limbs and has certainly improved quality of life in cancer patients. This is a rare case of unusual spindle cell sarcoma at distal femur where limb is salvaged.
Dr Manoj Pahukar
Consultant orthopaedic surgeon
MS, DNB Orth, MNAMS, FKS Belgium, SICOT, AO Fellow Hongkong
