Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic f
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ORIGINAL PAPER
Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study Khodamorad Jamshidi 1 & Farshad Zandrahimi 1 & Milad Haji Agha Bozorgi 1 & Amir Mohammad Arefpour 1 & Abolfazl Bagherifard 1 & Hamadalla Hadi Al-Baseesee 2 & Alireza Mirzaei 1 Received: 24 July 2020 / Accepted: 25 September 2020 # SICOT aisbl 2020
Abstract Purpose For the treatment of giant cell tumour of the bone (GCTB) around the knee, preserving the native joint confers advantages over scarifying it. But, there is a controversy about the efficacy of intralesional curettage versus en bloc resection for treatment of such lesions. In this study, we compared local recurrence, functional outcomes, and complications of extended curettage and en bloc resection in these lesions. Methods Patients with grade 3 GCTB of the distal femur or proximal tibia who were presented with a pathologic fracture and treated with either en bloc resection (n = 22) or extended curettage (n = 20) were included. The mean follow-up of the patients was 6.4 ± 1.9 years in the resection group and 5.5 ± 2.4 years in the extended curettage group. The primary outcome was a local recurrence. Secondary outcomes were limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score and rate of complications. Results Local recurrence was seen in four (20%) patients of the curettage group and three (13.7%) patients of the resection group (P = 0.69). The mean MSTS score was 24 ± 1.9 in the resection group and 26.5 ± 1.3 in the curettage group (P < 0.001). The number of complications was not significantly different between the two study groups (P = 0.49). However, the number of complications that required revision surgery was significantly more in the resection group (P = 0.049). Conclusion In grade 3 GCTB around the knee with pathologic fracture, extended curettage results in comparable oncologic outcomes to en bloc resection, while providing better function and a lower rate of revision. Keywords Giant cell tumour . Pathologic fracture . Extended curettage . En bloc resection
Introduction Giant cell tumour of bone (GCTB) is a benign but locally aggressive tumour that generally involves the epimetaphyseal region of the long bones [1]. It comprises 5% of all primary bone tumours and most frequently occurs in the distal femur (35%) or proximal tibia (18%) of young adults in the age range of 20–40 years [1].
* Alireza Mirzaei [email protected] 1
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
2
College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq
The main concern about the management of GCTB is the incidence of local recurrence, which is reported to occur in about 0–65% of patients, depending on the grade of the disease and the presence of pathologic fracture [2]. Cortical breakdown and soft tissue extension (Campanacci grade 3) [3] and pathologic fracture [4, 5] are acknowledged as the
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