Local recurrence in giant cell tumor of bone: Comparative study of two methods of surgical approach

Abstract

• BACKGROUND: Most experts accept the use of curettage, phenol, and cement as the best treatment to prevent recurrence of giant-cell tumors. The purpose of this investigation was to analyze the effect of cement as a filling material and compare it with bone graft and the effect of high-speed burr in local recurrence of giant cell tumor after curettage.
• METHODS: We retrospectively reviewed 168 consecutive patients diagnosed with giant cell tumor at the three most common sites (distal femur, proximal tibia, and distal radius) to determine the pattern of local tumor recurrence. Only patients who had intralesional excision of primary tumor by curettage without a surgical adjuvant were included.
• RESULTS: A total of 168 patients with primary giant cell tumor were treated with curettage. The female to male ratio was 1.4: 1 and the mean age was 34 years (range: 17-68 years). The minimum follow-up was 24 months and the median follow up was 75 months. The knee region was involved in 135 (80.4%) patients. There were 10 (5.9%), 130 (77.4%) and 28 (16.7%) patients in Campanacci grade I, II and III, respectively. Tumor surgery was supplemented with high speed burring in 88 (52.4%), bone cement in 82 (48.8%) and bone grafting, either autograft or allograft in 86 (51.2%) patients. The recurrence rates were 18.2% and 37.5% for curettage with or without high speed burring, respectively. For 46 (27%) recurrent lesions treated by curettage, the recurrence rate was 35%. The nature of the filling material used did not show any significant impact on the outcome of recurrence rate.
• CONCLUSIONS: Despite the high rates of recurrence after treatment of giant-cell tumor with curettage, the results of the present study suggested that the high-speed burr is effective in reducing the rate of recurrence. The risk of local recurrence after curettage with a high-speed burr and reconstruction with bone graft is similar to that observed after using cement. It is likely that the adequacy of the removal of the tumor rather than the use of adjuvant modalities is what determines the risk of recurrence.
• KEYWORDS: Giant cell tumor, recurrence, bone graft, cement.