Clinical analysis of aggressive curettage with bone grafting and tumor resection with reconstruction for giant cell tumor of proximal femur

Abstract

Objective To compare the clinical outcome of aggressive curettage with bone grafting and bone tumor resection with reconstruction of patients with proximal femoral giant cell tumor, and to analyzed the factors affecting rehabilitation of lower limb motor function, perioperative complications and tumor recurrence. Methods A retrospective analysis of 35 patients with giant cell tumor of the proximal femur was conducted in the Affiliated Tumor Hospital of China Medical University from January 2013 to December 2017.There were 18 male patients and 17 female patients, the average age was (39.85±11.59) years. According to the patient's tumor location, imaging classification and Giant Cell Tumor Team of China(GTOC) scores, patients received the treatment of aggressive curettage with bone grafting(15 patients) or bone tumor resection with reconstruction(20 patients). The patients received postoperative follow-up regularly. The duration of surgery, intraoperative blood loss, postoperative assisted walking time, short-term complications, Musculoskeletal Tumor Society(MSTS) scores of lower limb function and tumor recurrence were compared between the two procedures. The effects of pathological fracture, International Society of Limb Salvage(ISOLS) proximal tumor segmentation, Campanacci classification, surgical procedure and tumor volume on tumor relapse and lower limb function recovery were compared. Results All patients were followed up for 4-60(33.50±16.65) months. Two patients died of tumor metastasis at 6 and 8 months after surgery, and one patient died unexpectedly 6 months postoperative. The MSTS scores of lower limb function in patients with pathological fractures were 20.00±3.33, and in patients without pathological fractures were (22.88±3.81), there was significant different in statistics analysis (t=2.381, P 0.05). Conclusions Aggressive curettage with bone grafting and bone tumor resection with reconstruction can achieve similar lower limbs functional recovery and the same level of tumor recurrence rate.Due to the larger orientation of the tumor resection and reconstruction, the intraoperative blood loss and short-term complications was higher. Preoperative pathological fractures had a negative impact on the recovery of postoperative lower limb function. Key words: Femoral neoplasms; Giant cell tumor of bone; Tumor resection with reconstruction; Reconstruction of tumor segment; Proximal femur