Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts.

Singaravadivelu V,Kavinkumar V

doi:10.5704/moj.2011.008

Abstract

Introduction:Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage.Materials and Methods:This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score.Results:There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%.Conclusion:Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.

Highlights

Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery
Giant cell tumour is a common bone tumour accounting for 5% of all primary bone tumours
With the advancement in treatment options, the recurrence rate associated with GCT has fallen from an excess of 40% to less than 20% with extended curettage and use of adjuvants[2,3,4]

Summary

Introduction

Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage. Conclusion: Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function. The cavity left behind following the curettage is commonly filled with a bone graft or bone cement. Studies in literature[5,6] had reported higher recurrence rates when iliac crest bone graft was used to fill the cavity. Bone cement is an inert material and does not get incorporated or remodelled along the lines of stress

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