Bone Tumors Around the Knee
Bone tumors are commonly located around the knee, in the distal femur and proximal tibia and less frequently in the proximal fibula and patella. Treatment of bone tumors depends on the histological grade, the size and location of the tumor and the charact
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Manuel Peleteiro-Pensado, Irene Barrientos-Ruiz, and Eduardo J. Ortiz-Cruz
Abstract
Bone tumors are commonly located around the knee, in the distal femur and proximal tibia and less frequently in the proximal fibula and patella. Treatment of bone tumors depends on the histological grade, the size and location of the tumor and the characteristics of the patient. Generally, benign bone tumors are adequately treated by either an intralesional or a marginal resection. To reduce the risk of recurrence, the intralesional resection may be extended with mechanical, chemical, and thermal adjuncts. Primary bone sarcomas and some aggressive benign tumors require a wide resection. Limb salvage principles are largely employed if neurovascular structures can be preserved and a level of function maintained. After tumor resection with a wide margin, the defect left poses a reconstructive challenge. In this chapter, we will refer to bone tumors that most frequently arise around the knee and may affect adult population. First, we consider the basic characteristics of these tumors and then the surgical treatment, focusing in those techniques that preserve the joint. Keywords
Knee • Bone tumors • Diagnosis • Treatment
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M. Peleteiro-Pensado (*) • I. Barrientos-Ruiz E.J. Ortiz-Cruz Department of Orthopedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain e-mail: [email protected]; irenebarrientosruiz@ gmail.com; [email protected]
Introduction
Primary tumors of bone are relatively uncommon, but a significant proportion of cases arise around the knee. It is likely that the distal femur and proximal tibia and fibula are common sites of bone tumor location because they are highly vascularized areas, with very active physes. The patella, however, is only rarely affected. Bone tumors around the knee occur in those ages when
© Springer International Publishing Switzerland 2017 E.C. Rodríguez-Merchán, A.D. Liddle (eds.), Joint Preservation in the Adult Knee, DOI 10.1007/978-3-319-41808-7_13
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the skeleton is in growth phase and especially in a range between 5 and 20 years, with the exception of the giant cell tumor and chondrosarcoma which most commonly affect adults. Any benign or malignant bone tumor can arise in the knee region. Among benign bone tumors, between 30 and 35 % of chondroblastomas, 50 % of osteochondromas and 60 % of giant cell tumors affect this region. Of malignant primary bone tumors, 50 % of osteosarcomas arise here but only 12–15 % of chondrosarcomas. A high percentage of nonossifying fibroma are located at the distal end of the femur, up to 90 % in some series. Aneurysmal bone cysts have a predilection for the proximal tibia [1–4]. Clinical manifestations are pain, but occasionally a mass and swelling can be felt at the tumor site. Some benign tumors and inactive or indolent lesions (such as enchondroma and non ossifying fibroma), have no symptoms or are discovered in a radiological examination for other reasons. Occ
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