Extended curettage, bone grafting, and spanning external fixation for the treatment of juxta-articular giant cell tumor of the bone around the knee

Abstract

Background Treatment of juxta-articular giant cell tumor (GCT) of the bone around the knee remains a dilemma. Many authors recommend cementing, others grafting after extended curettage and others resect and replace by a modular prosthesis. Biological reconstruction remains the cornerstone of our belief in the treatment of GCT. Materials and methods A retrospective review was conducted of GCT around the knee treated between 2000 and 2012 using the technique of extended curettage through a large bone window in situ pasteurization (ISP), followed by bone grafting and spanning external fixation. Thirty patients (10 men, 20 women), aged from 15 to 67 years (average 38 years) with a mean duration of follow-up of 46 months (range: 24–188 months) were identified. The GCTs were staged according to the system of Campanacci and colleagues. Six lesions were classified as stage I, 18 as stage II, and six as stage III. Four patients had an intra-articular fracture of the distal femur at the time of diagnosis. Results All 30 patients are continuously free of disease and there is no local recurrence. Functional evaluation was performed by the International Society of Limb Salvage score criteria. The average functional score was 95% (77–100%). None of the patients complained of pain and none of the patients demonstrated serious instability of the knee joint. All the patients showed union starting from 2 months after surgery with full consolidation 6 months after surgery. The fixator was removed at 4–12 months after surgery. Radiologically, 29 (97%) patients had complete incorporation of the graft (>75% of the International Society of Limb Salvage score) and one (3%) patient had partial incorporation ( Conclusion Extended curettage, ISP bone grafting, and spanning external fixation is a safe and effective procedure for the treatment of juxta-articular GCT of the bone around the knee.