Objective: To analyse long term outcome of pedicled patellar implantation in treating the defect of the knee joint after the excision of giant cell tumor of distal femur.

Methods: The geometry of patella has lead to its use for condylar reconstruction following resection for giant cell tumour around knee. 15 such patients were treated at our institute and followed up for a mean period of 7.3 years. Average age at presentation was 14.8 years. All patients had plain x-rays, angiography as needed, CT scan and MRI to check integrity of articular cartilage and ACL. Size of lesion was measured on CT. Predominant lateral condyle involvement was found in 6 and medial in 9 patients. The patella was dissociated with a slip of quadriceps attached to its proximal superior-medial pole and rotated to place it horizontally in the zone of resection. Firm osteosynthesis to intact condyle and autogenous bone grafting was carried out.

Results: Grafts consolidated at a mean of 10.8 months. All joints were fairly stable and 70% had movement of 90 degrees without pain. 11 patients had excellent outcome with ability to carry on occupations involving manual labour. There were reoperations for 2 deep infections, 1 recurrence leading to arthrodesis, 1 supracondylar fracture, 2 arthrolysis and 1 valgus osteotomy. 4 patients had arthritic changes and extensor leg at 6 years follow up. No AVN changes or extensor mechanism problems occurred. Using chi square test for log rank analysis significant relationship was found between size of lesion and range of motion (P=0.03) as well as articular cartilage grading and development of arthrosis. The rate of healing was faster than other series reporting free patella grafting.

Conclusion: Patellar implantation is a suitable way to repair the defect of the knee with better immediate functional results subsequently delaying eventual prosthesis surgery.

The aim of this study was to evaluate whether duration of surgery correlates with the survival and final outcome of the patient with metastatic bone disease.

Between 1999 and 2002, 23 consecutive patients with impending or complete pathological fractures of the femur due to metastatic bone disease caused by variety of malignancies or an unknown primary were reviewed. These fractures were treated with intramedullary fixation in the form of long intramedullary hip screw, long Gamma nail or AO nail. These patients were followed up clinically and radiologically until death from the primary disease.

The results obtained demonstrate a mean survival time between 9 days to 12 months. Pain relief was achieved in 90% patients. Ambulatory status was improved in 47% patients. The postoperative course was complicated by four technical and five systemic complications. Intramedullary nailing is a safe and effective method in the treatment of metastatic bone disease. It provides good functional result with pain relief and improved mobility. The operating time does not predictably correlate with the survival and final outcome of the patient.