Patient Dao Thi Thu H., 25 years old, residing in Dak Lak province, was taken by her family to K Hospital, Tan Trieu facility, for examination because of pain and loss of movement in her right leg for many days.
The patient has been treated at many medical facilities with a diagnosis of giant cell tumor of bone. He has undergone bone tumor curettage surgery twice. Currently, the tumor has recurred and spread, causing deformity of the right knee joint and loss of mobility in the right leg. The large tumor compresses the right leg, causing pain, greatly affecting daily activities and life.
Photo of patient H.'s bone tumor (photo source: Ministry of Health).
Ms. H. was re-examined and was advised to have a thigh amputation due to the inability to preserve it. At a very young age, Ms. H. was very disappointed and shocked when receiving this information.
With little hope left, Ms. H. went to K Hospital with a lot of worries. Through examination and CT scan, the doctors determined that the patient had a tumor measuring 15x20cm in the right calf spreading to the lower third of the right thigh measuring 15x20cm. The pathological result of patient H. was giant cell tumor of bone.
This was determined to be a difficult case because the tumor was very large, spreading across the right thigh and calf, related to large blood vessels and nerves in the right hamstring area. Dr. Hoang Tuan Anh - Head of the Department of Musculoskeletal Surgery and other doctors in the Department agreed to prescribe a wide tumor excision and total knee replacement with a long-stem module that was personalized to the patient's tumor during surgical removal.
Along with that, BSCKII. Hoang Tuan Anh also consulted with Professor Tran Trung Dung, one of the professors with a lot of experience in Modul joint replacement, consulted the whole hospital, doctors of the Department of Anesthesia and Resuscitation of K Hospital on anesthesia plan, blood reserve, setting up central venous lines, closely monitoring patients throughout the surgery to have timely treatment plan.
With the nature of a difficult case, high risk of complications, especially blood loss and nerve damage, in addition to meticulous and precise surgical planning, Dr. Hoang Tuan Anh also explained thoroughly and encouraged the patient and family.
The team is determined to successfully perform the difficult surgery with the desire to preserve the patient's leg.
With the determination to treat the patient and his family's illness, in early October 2023, Dr. Hoang Tuan Anh and the surgical team of the Department of Musculoskeletal Surgery at K Hospital decided to perform surgery to remove the tumor and replace the patient's total knee.
Intraoperative evaluation of the recurrent giant cell tumor of the right tibia showed extensive invasion of the lower third of the right thigh muscle, the right calf muscle bundles, the right popliteal artery, the tumor enclosing the popliteal artery and the greater sciatic nerve, the tibial nerve and the deep peroneal nerve, invading the entire joint surface of the right tibia, part of the patellar surface and the medial femoral condyle.
The surgery lasted more than 5 hours, the process of dissecting the tumor was difficult because the tumor was large, the tumor was located around the neurovascular bundle, due to the 2 recurrences of surgery, the loss of natural anatomical layers with the vascular bundle, the risk of tearing the vascular bundle and damaging the nerve branches and main motor muscle groups of the lower leg, making dissection difficult.
The tumor recurs in the muscle bundles, so removing the entire tumor and ensuring the cut surface is free of tumor is the key to limiting recurrence after surgery.
The patient underwent wide resection of the tibia with tumor and part of the lower head of the femur and infiltrated quadriceps muscle bundles, and total knee replacement with long-stem modular right knee replacement customized to the patient's tumor lesion.
After a long surgery, along with post-operative care and rehabilitation immediately after surgery, and encouragement from the doctors and nurses of the Department of Musculoskeletal Surgery, patient H.'s health progressed and recovered very quickly. The patient was able to walk again with the support of medical staff in the first week after surgery at the department. Currently, the patient can walk on his own with crutches.
The patient's husband said: "My wife has been treated in many hospitals, had surgery twice but both times the disease relapsed and she could not walk. Many hospitals recommended amputation of the thigh.
My family is very sad and worried because my wife is young and the children are small, and the future is long. If she loses a leg, it will be very difficult for the whole family's life and psychology.
When we arrived at K Hospital and the doctors treated and saved my wife's leg, my family was very happy and sincerely thanked the doctors and the hospital."
Postoperative evaluation of patient H. showed good leg motor function and gradually stabilized. Postoperative pathological results showed giant cell tumor of the right tibia.
Ten days after surgery, the patient was discharged from the hospital to go home, to the joy of the patient and his family.
Ms. H.'s quick recovery is a great joy, a priceless gift for the doctors and medical staff, and also a reward for the determination and trust of the patient and her family in K Hospital.
With the continuous development of techniques and methods in diagnosis and treatment of medicine in general and in the treatment of cancer in particular, K Hospital has applied many modern methods to treat cancer and has achieved many successes in improving the health of patients.
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