Long-term outcome of giant cell tumors around the knee with associated pathological fractures treated by curettage and cementation

Abstract

Objectives: The management of giant cell tumor (GCT) lesions around the knee is challenging. This study aimed to investigate the long-term outcome of treating GCTs around the knee with associated pathological fractures by curettage and adjuvant cementation with the use of high-speed burr. Methods: Fifty patients with a mean age of 28.3 years were included in the study. The tumor was located in the distal femur (40 patients) and proximal tibia (10 patients). Eighteen patients were Grade II Campanacci, whereas 32 patients were Grade III. The mean follow-up period was 65 months. Twenty-nine patients (58%) underwent extended curettage and bone cement. Twenty-one patients (42%) underwent extended curettage, bone cement, and internal fixation. High-speed burr was used in 45 patients (90%). Bone graft was used in 8 patients (16%). Functional evaluation was done using the Musculoskeletal Tumor Society (MSTS) scoring system for the lower extremity. Results: The overall MSTS score was excellent in 42 patients (84%), good in 5 patients (10%), fair in 2 patients (4%), and poor in 1 patient (2%). The overall local recurrence rate was 12% (6 cases) and a 10% complication rate. There were no cases of fracture nonunion or distant metastasis. Conclusions: GCTs around the knee with associated pathological fractures at diagnosis can be treated with extended curettage using high-speed burr and adjuvant cementation with favorable functional long-term outcome.