Table 1.
Operative details.
| Case | Diagnosis | Anesthesia | Position | Tourniquet | Pump | Portals | Adjuvant Grafts / Implants & Drain |
Operative time | Hospital stay | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Giant cell tumour proximal tibia | Spinal | Supine with knee elevation and bending | Yes | Yes (80 mmhg) | Antero-lateral portal just lateral to the patellar tendon near to the upper end of the lesion Antero-medial portal through the medial surface of the lesion near to its lower end using image intensifier |
Hydrogen peroxide Bone cement (PMMA) drain |
120 minutes | Three days | ||||||
| 2 | ABC proximal tibia | Spinal | Supine with knee elevation and bending | Yes | Yes (80 mmhg) | Antero-lateral portal just lateral to the patellar tendon near to the upper end of the lesion Antero-medial portal through the medial surface of the lesion near to its lower end using image intensifier |
Hydrogen peroxide Bone cement (PMMA) drain | 120 minutes | days | ||||||
| 3 | Giant cell tumour distal femur | Spinal | Supine with knee elevation and bending | Yes | Yes (80 mmhg) | Opposing antero-medial and antero- lateral portals on both sides of the upper end of the patella on either sides of the lesion using image intensifier | Hydrogen peroxide Bone cement (PMMA) No drain | 90 minutes | Three days | ||||||
| 4 | ABC Calcaneus | Spinal | Lateral with foot elevation and suspension | Yes | Yes (60 mmhg) | Two opposing portals at both medial and lateral surfaces of the calcaneus using image intensifier. | Hydrogen peroxide Bone cement (PMMA) No drain | 70 minutes | One day | ||||||
| 5 | UBC distal femur | General | Supine with thigh elevation and knee bending | Yes | Yes (100 mmhg) | Opposing antero-medial and antero- lateral portals on both sides of the upper end of the patella on either sides of the lesion using image intensifier. | No | 30 minutes | One day | ||||||
| 6 | Calcaneal lipoma | Spinal | Lateral with foot elevation and suspension | Yes | Yes (60 mmhg) | Two opposing portals at both medial and lateral surfaces of the calcaneus using image intensifier. | Hydrogen peroxide Bone cement (PMMA) No drain | 45 minutes | One day | ||||||
| 7 | Calcaneal lipoma | Spinal | Lateral with foot elevation and suspension | Yes | Yes (60 mmhg) | Two opposing portals at both medial and lateral surfaces of the calcaneus using image intensifier. | Hydrogen peroxide Bone cement (PMMA) No drain | 40 minutes | One day | ||||||
| 8 | UBC distal tibia | General | Supine with leg elevation | Yes | Yes (60 mmhg) | Anterior portal through the anterior aspect of the lesion near to its upper end Postero-medial portal at the posterior border of medial surface of the lesion near to its lower end using image intensifier. |
Drain | 45 minutes | One day | ||||||
| 9 | ABC proximal humerus | General Hypotensive measures | Supine semi setting | No | Yes (100 mmhg) | Two portals through the anterior fibers of the deltoid just lateral to the long head of biceps at both upper and lower ends of the lesion using image intensifier. | Drain | 90 minutes | Two days | ||||||
| 10 | Cystic fibrous dysplasia proximal tibia | Spinal | Supine with leg elevation and knee bending | Yes | Yes (60 mmhg) | Antero-lateral portal just lateral to the patellar tendon near to the upper end of the lesion Antero-medial portal through the medial surface of the lesion near to its lower end using image intensifier. |
Drain | 30 minutes | One day | ||||||
| 11 | Chondroblastoma proximal tibia | Spinal | Supine with knee bending and elevation | Yes | Yes (80 mmhg) | Anterior portal medial to the patellar tendon Medial portal through the medial surface of the lesion using image intensifier. |
Hydrogen peroxide Autogenous iliac bone grafts No drain |
60 minutes | Two days | ||||||
| 12 | UBC distal femur | Spinal | Supine with thigh elevation and knee bending | Yes | Yes (80 mmhg) | Opposing antero-medial and antero- lateral portals on both sides of the upper end of the patella on either sides of the lesion using image intensifier. | Drain | 30 minutes | Two days | ||||||
| 13 | UBC distal tibia | General | Supine with leg elevation | Yes | Yes (60 mmhg) | Anterior portal through the anterior aspect of the lesion near to its upper end Postero-medial portal at the posterior border of medial surface of the lesion near to its lower end using image intensifier. |
Drain | 20 minutes | Two days | ||||||
| 14 | UBC proximal humerus | General Hypotensive measures |
Supine semi setting | No | Yes (100 mmhg) | Two portals through the anterior fibers of the deltoid just lateral to the long head of biceps at both upper and lower ends of the lesion using image intensifier. | Drain | 40 minutes | Two days | ||||||
| 15 | ABC distal tibia | General | Supine with leg elevation | Yes | Yes (60 mmhg) | Antero-medial portal through the medial surface of the lesion Antero-lateral portal through the lateral surface of the lesion using image intensifier. |
Drain | 30 minutes | Two days | ||||||
| 16 | ABC proximal tibia | General | Supine with knee elevation | Yes | Yes (80 mmhg) | Antero-medial portal through the medial surface of the lesion near to its upper end Antero-lateral portal through the lateral surface of the lesion near to its lower end using image intensifier. |
Above knee cast No drain |
30 minutes | One day | ||||||
| 17 | ABC proximal femur | General Hypotensive measures |
Supine with hip flexion and thigh elevation | No | Yes (100 mmhg) | Anterior portal through the quadriceps at the anterior border of the lesion near to its upper end. Postero-lateral portal through vastus lateralis near to its lower end using image intensifier. |
Two intra-medullary flexible nails No drain |
60 minutes | Two days | ||||||
| 18 | Lipoma head of talus | General | Supine with foot elevation | yes | Yes (60 mmhg) | Antero-medial portal of the ankle just below the anterior tip of medial malleolus adjacent to the tibialis anterior tendon Antero-lateral portal of the ankle at sinus tarsi anterior to the peroneal tendons opposing to the other portal using image intensifier. |
Autogenous iliac bone grafts No drain |
45 minutes | One day | ||||||
| 19 | ABC distal fibula | Spinal | Supine with leg elevation | yes | Yes (80 mmhg) | Two portals direct on the distal fibula One at the upper end of lesion adjacent to its anterior border The other one at the lower end of the lesion adjacent to its posterior border. |
No | 45 minutes | One day | ||||||
| 20 | Calcaneal lipoma | Spinal | Lateral with foot elevation and suspension | yes | Yes (60 mmhg) | Two opposing portals at both medial and lateral surfaces of the calcaneus using image intensifier. | No | 15 minutes | One day | ||||||
| 21 | Chondroblastoma distal femur | Spinal | Supine with knee elevation | yes | Yes (80 mmhg) | Antero-medial portal adjacent to the medial border of the patella near to the upper end of the lesion. Postero-medial portal adjacent to the posterior aspect of the medial femoral condyle near to the lower end of the lesion using image intensifier. |
Hydrogen peroxide Autogenous iliac bone grafts No drain |
60 minutes | One day | ||||||
| 22 | Giant cell tumour distal femur | Spinal | Supine with knee elevation | yes | Yes (80 mmhg) | Antero-medial portal adjacent to the medial border of the patella near to the upper end of the lesion. Postero-medial portal adjacent to the posterior aspect of the medial femoral condyle near to the lower end of the lesion using image intensifier. |
Hydrogen peroxide Bone cement (PMMA) No drain | 60 minutes | One day | ||||||
| 23 | UBC proximal humerus | General Hypotensive measures |
Supine Semi setting | No | Yes (100 mmhg) | Two portals through the anterior fibers of the deltoid just lateral to the long head of biceps at both upper and lower ends of the lesion using image intensifier. | No | 30 minutes | One day | ||||||
| 24 | Non ossifying fibroma proximal tibia | Spinal | Supine with knee elevation | yes | Yes (60 mmhg) | Two portals direct on the medial surface of proximal tibial metaphysis at both upper and lower ends of the lesion using image intensifier. | No | 30 minutes | One day | ||||||
| 25 | ABC Body of talus |
Spinal | Supine With Foot external rotation |
yes | Yes (60 mmhg) | Antero-medial to the ankle just below the anterior tip of the medial malleolus adjacent to the tibialis anterior tendon. Postro-medial to the ankle just anterior to the medial border of the Achilles tendon at the same level opposite to the other portal. |
Hydrogen peroxide Autogenous iliac bone grafts No drain | 45 minutes | One day | ||||||
| 26 | Chondroblastoma Distal femur | general | Supine With Knee elevation |
yes | Yes (60 mmhg) | Single portal direct on medial femoral condyle using image intensifier. | Ethanol Autogenous iliac bone Grafts No drain |
45 minutes | One day | ||||||
UBC = unicameral bone cyst, ABC = aneurysmal bone cyst.