Eighteen-year-old Khushnood Aslam came to the OPD of Narayana Hospital, Howrah, with pain and swelling over his left thigh and knee since July 2024. The excruciating pain prevented him from doing even his daily activities. Numerous investigations and scans had failed to offer any diagnosis.

“We did a needle biopsy followed by a PET scan. The patient was diagnosed with high-grade chondroblastic osteosarcoma, which was nonmetastatic,” says Dr Nishith Praveenchandra Gupta, Consultant - Musculoskeletal Oncology at Narayana Hospital, Howrah. Khushnood was started on neoadjuvant chemotherapy of 4 cycles, followed by surgical excision and thereafter, another 4 cycles of adjuvant chemotherapy.

The big challenge before Dr Gupta and his team was to ensure that the intervention went complication-free. The tumour was close to the knee joint. Hence, saving the knee joint while ensuring complete removal of the tumour was the top priority. Also, the major blood vessels and nerves were very close to the tumour.

Another challenge was reconstruction after the removal of the tumour. “The plan was to recycle the tumour bone by radiation with strict aseptic precautions and then use the same bone for reconstruction. Meticulous planning and intraoperative dissection were done to achieve complete clearance of the tumour,” explains Dr Gupta. The removed bone was sent for radiation to destroy the tumour cells with strict aseptic precautions. Then the bone was replanted and fixed with implants.

The entire surgery took 9 hours. Post-surgery, the patient was discharged and later, after suture removal, underwent adjuvant chemotherapy of 4 cycles. In all, Khushnood stayed in hospital for 8 days.

“What makes this case so unique is that the tumour was lying very close to the joint and blood vessels. Ensuring complete removal of the tumour and preserving the knee joint was a challenge. After removal, reconstruction options are limited, and among the available options, the patient’s own sterilised bone has advantages as it is size-matched,” adds Dr Gupta.
Ensuring sterility of the entire procedure required seamless teamwork. After replanting, the bone reconstruction had to be planned in such a way that it’s durable and stable, allowing immediate mobilisation of the patient. This was achieved by a combination of implants.

This was a rare procedure of sterilising the tumour bone and using it for reconstruction and salvaging the knee joint.