Abstract
Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 patients had full extension and knee flexion more than 100 degrees. The mean MSTS score was 25.2. Three patients had an MSTS score under 20. All three patients had an extension lag with a restricted range of motion. Conclusion: Joint preservation surgery, when done in line with the basic principles of tumor surgery, gives good radiographic and functional outcomes even in grade 2 and 3 giant cell tumors of bone around the knee and should be attempted before replacement surgeries.
Highlights
Giant cell tumor (GCT) of bone is a common affliction constituting about 5% of all primary bone tumors involving the meta-epiphyseal region and affecting patients mostly in the second and third decade of their lives
The most common location is around the knee joint, i.e., distal femur and proximal tibia [1, 2]
Keeping in mind the principles of tumor surgeries and intralesional curettage, joint preservation surgeries coupled with local ablative methods against tumor cells like a high-speed burr, phenol, liquid nitrogen, and cauterization have given good results even in high-grade lesions
Summary
Giant cell tumor (GCT) of bone is a common affliction constituting about 5% of all primary bone tumors involving the meta-epiphyseal region and affecting patients mostly in the second and third decade of their lives. Replacement with custom-made tumor prosthesis after resection has significantly increased in the recent decades because of less chance of recurrence, early mobilization, and restoration of joint function Though it appears to give good results in the short term [3,4,5], the long-term follow-up results and its survivorship data paint a different picture, especially in young patients who have more than 40 years of life expectancy after the procedure [6,7,8]. Keeping in mind the principles of tumor surgeries and intralesional curettage, joint preservation surgeries coupled with local ablative methods against tumor cells like a high-speed burr, phenol, liquid nitrogen, and cauterization have given good results even in high-grade lesions Though it does not allow immediate mobilization and early rehabilitation like replacement surgeries and requires frequent follow-up visits, which may be exhausting for that patient and their families, it does a great job of preserving the native joint and has better outcomes in the long term
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