Surgical treatment of giant cell tumors with pathological fracture around the knee

Abstract

Objective: To compare the local recurrent rate, the persistence of reconstruction and functional recovery of Giant Cell Tumor (GCT) after the treatments of extensive curettage or resection. Methods: A retrospective review was conducted on the clinical data of 50 patients who had giant cell tumor with pathological tracture around the knee treated in our hospital from January 2001 to July 2014. There were 30 males and 20 females. The average age was 33.7 years respectively (range, 17 to 71 years). The fracture localizations of 45 cases were distal femur and of 5 cases were proximal tibia. According to AO fracture classification, 3 cases were in type A, 36 cases in type B and 11 cases in type C. In Campanicci system for image grading study, 5 cases were in grade Ⅱ and 45 cases in grade Ⅲ. Surgical treatment included 20 cases of extensive curettage and 30 cases of resection. The surgical reconstructive methods included 16 cases of cement reconstruction with internal fixation, 5 cases of unicompartmental arthroplasty with allograft, 1 case of segment osteoarticular allograft transplantation and 28 cases of prosthesis replacement. Final statistical analysis of surgery and therapeutic effect were carried out by SPSS, version 16.0 for Windows. Enrolling parameters collected gender, age, location, fracture type, surgical treatment, surgical margin, reconstruction, complications, local recurrence (LR) and functional evaluation. Categorical data were described by result frequencies.The comparison of the rate was performed by chi-square or Fisher's exact test. Between the two groups compared using independent t-test. The recurrence-free survival was estimated by the method of Kaplan-Meier. Results: The mean postoperative follow-up time was 66.9 months (range, 24-149 months). Four patients developed local recurrence (4/50, 8.0%)including 3 cases of curettage group (3/20, 15.0%)and 1 case of resection group (1/30, 3.3%), there was no significant difference between curettage and resection group (P=0.289). The comparison of local recurrence between this curettage group (3/20, 15.0%) and the GCT group without fracture published before(10/116, 8.6%) in our institution also had no significant difference (P=0.407). There was no significant difference among the three types of fracture regarding the rate of local recurrence (P=0.160), but there was significant difference in the choice of surgical procedures for different fracture types (P=0.006). The complications: 2 patients (2/20, 10.0%)had joint degeneration in curettage group. 15 cases (15/30, 50.0%) had complications in resection group, 1 case of unicompartmental arthroplasty allograft absorption, 2 cases of infection and 12 cases of aseptic loosening after prosthesis replacement (including 1 case with periprosthetic fracture and 1 case with prosthesis fracture). The postoperative complications in curettage group had a significant reduction (P=0.005) when compared with the resection group. The mean score of functional evaluation with Musculoskeletal Tumor Society (MSTS) for curettage and resection group were (93.5±6.5)% and (82.6±12.9)% (F=4.838, P=0.033). Conclusions: (1) Extensive curettage did not increase the risk of local recurrence of giant cell tumor with pathological fracture around the knee. (2)The different fracture type had no effect on the local recurrence rate, but affect the decision of surgical procedures options. (3)The reconstructive complications in resection group was significant higher than curettage group, and the postoperative function of curettage group was better than resection group.