Abstract
AimAs a locally destructive intermediate bone tumor with low incidence, high recurrence rate, and difficulty in reconstruction, giant cell tumor of bone (GCTB) in the proximal femur has no unified surgical treatment standard. This study aimed to compare the differences in local recurrence, reconstruction durability, and postoperative function after treatment with either extended curettage (EC) or segmental resection (SR) for GCTB in the proximal femur so as to provide constructive suggestions for the rational selection of EC or SR operation scheme.Patients and Methods29 patients (15 men and 14 women) were included in this retrospective study, with a mean age of 32.1 years. According to the division method of proximal femur of International Society Of Limb Salvage (ISOLS), there was 1 case in the H1 area, 17 cases in the H2 area, 10 cases in the H1+H2 area, and 1 case in the H1+H2+H3 area. Among them were 11 cases of Campanacci grade II GCTB, 18 cases of Campanacci grade III GCTB, and 7 cases with pathological fractures. All patients underwent either EC or SR surgery. The Musculoskeletal Tumor Society (MSTS) score was used for patient evaluation. The operation effectiveness was analyzed according to the Mankin evaluation standard. Regular follow-up was performed to evaluate the recurrence rate, limb function, and long-term complications of the two surgical methods.ResultsAll patients were followed up for a mean of 60.4 months. Local recurrence occurred in one of 19 patients treated with EC (5.3%) and one of 10 patients treated with SR (10%). The MSTS score of lower limb function in patients in the EC group was better compared to patients in the SR group (P = 0.002). Complications occurred in 2 cases (10.5%) and 5 cases (50%) in the EC group (osteoarthritis, osteonecrosis) and SR group (joint stiffness, infection, prosthesis loosening), respectively, with significant differences between the two groups (P = 0.03). The operation effectiveness was analyzed according to the Mankin evaluation standard. The EC group showed an optimal rate of 94.7% (18/19) as opposed to 80% (8/10) in the SR group.ConclusionsFor GCTB in the proximal femur, when the tumor does not extensively involves the surrounding soft tissues, the articular surface was not damaged, and there is no pathological fracture with apparent displacement, EC surgery should be fully considered.
Highlights
Giant cell tumor of bone (GCTB) is a common primary bone tumor and possesses characteristics of unpredictable biological behavior, severe bone erosion, and a high recurrence rate [1]
This study aims to study the clinical efficacy of extended curettage (EC) and segmental resection (SR) on proximal femoral GCTB and analyze the differences between the two surgical methods in terms of recurrence rate, functional reconstruction, postoperative complications, etc
According to the original data of patients (Table 1), there were 19 patients (11 men and 8 women) in the EC group, with an average age of 32.3 years. This group included 10 cases of Campanacci grade II and 9 cases of Campanacci grade III. 12 cases were located in the H2 area (Figure 1), 6 cases in the H1 + H2 area (Figure 3), 1 case in H1 + H2 + H3 area (Figure 4), and 2 cases had pathological fractures before the procedure
Summary
Giant cell tumor of bone (GCTB) is a common primary bone tumor and possesses characteristics of unpredictable biological behavior, severe bone erosion, and a high recurrence rate [1]. The age of onset is mainly between 20 and 40 years old, women are more common [2]. It is defined as a locally destructive intermediate bone tumor due to its strong bone and soft tissue invasiveness. The epiphyseal regions of the distal femur and proximal tibia are the most common sites, accounting for about 60% - 70% of GCTB in all body parts [3]. The prognosis varies according to the anatomical site of GCTB. The study of GCTB in different anatomical parts is a must [2, 3]
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