Joint Preservation after Extensive Curettage of Knee Giant Cell Tumors

• Published in: Clinical orthopaedics and related research 2009-11, Vol.467 (11), p.2845-2851
• Main Authors: Ayerza, Miguel A., Aponte-Tinao, Luis A., Farfalli, German L., Lores Restrepo, Carlos A., Muscolo, D. Luis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Bone Nails; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Bone Plates; Bone Transplantation - methods; Cohort Studies; Conservative Orthopedics; Curettage - methods; Diseases of the osteoarticular system; Female; Follow-Up Studies; Giant Cell Tumor of Bone - pathology; Giant Cell Tumor of Bone - surgery; Graft Survival; Humans; Knee Joint; Limb Salvage - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Menisci, Tibial - pathology; Menisci, Tibial - surgery; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Orthopedics; Radiography; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Recovery of Function; Retrospective Studies; Risk Assessment; Sports Medicine; Surgery; Surgical Orthopedics; Survival Analysis; Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society; Transplantation, Homologous; Treatment Outcome; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-0913-8

Curettage is the most attractive procedure for surgically treating a giant cell tumor because it preserves joint function. However, since many giant cell tumors compromise subchondral bone this technique can jeopardize the articular surface with subsequent fractures or collapse. We asked whether intralesional curettage of a giant cell tumor close to the knee that combined morselized bone and cortical structural allograft would preserve joint function. We retrospectively reviewed 22 patients treated with that approach. The minimum followup was 2 years (average, 48 months; range, 24–80 months). The distal femur was involved in 12 patients and proximal tibia in 10. Complications and failures were recorded and functional results evaluated with Musculoskeletal Tumor Society score. We determined survivorship using the Kaplan-Meier technique using removal of the implant as the endpoint. The survival was 85% and the average functional score 28 points. Three of the 22 patients had a local tumor recurrence and one had a partial subchondral collapse not requiring further treatment. Among the remaining patients, none had fracture, infection, or knee instability. The combination of fragmented and cortical allograft allows reconstructing the bone defect and ligaments created after extensive curettage of a knee giant cell tumor obtaining normal joint function and a high survival rate with minimal complications in a high percentage of the patients. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.