The Outcomes of Treatment of Giant Cell Tumor of Bone around the Knee
Apichat Asavamongkolkul MD*, Perajit Eamsobhana MD*, Saranatra Waikakul MD*, Rapin Phimolsarnti MD*
Affiliation : * Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Giant cell tumor of bone has been characterized as an aggressive benign bone tumor and commonly occurs at
the distal femur and the proximal tibia. The recommended treatment has ranged from intralesional curettage to wide excision
and the decision depends on severity of the tumor extent, rate of local recurrence, functional and morbidity outcomes.
Objective : To compare extended curettage and wide excision in Grade II-III giant cell tumor of bone around the knee with
regard to their effectiveness in tumor control and complication.
Material and Method: There were 54 patients with a giant cell tumor which involved the distal femur or proximal tibia who
had been managed consecutively at Siriraj Hospital between 1994-2009. The lesion of all patients were staged according to
the system of Campanacci et al. There were 21 males and 33 females with mean age of 34 years. Thirty-five tumors located
at distal femur and 19 located at proximal tibia. Fourteen patients had a Grade II lesion and 40 had a Grade III lesion. Thirty
patients received extended curettage whereas other 24 patients had a wide excision. Fisher’s exact analysis was used for
statistical analysis for the outcome of tumor recurrence in each surgery.
Results : The mean follow-up time was 59 months. There were 7 (23.3 percent) local recurrences in the extended curettage
group and 2 (8.3 percent) in the wide excision group. Most recurrences occurred within one year postoperatively. There was
no statistical difference for the outcome of tumor recurrence in each group (p = 0.270). All patients with tumor recurrence
were successfully treated with re-curettage, except for 3 patients who was treated by above-knee amputation. The functional
analysis was excellence in the extended curettage group (94 percent) and good in the wide excision group (77.6 percent)
according to the Musculoskeletal Tumor Society functional classification.
Conclusion : The authors believe that using extended curettage was not significantly different in percentage of local recurrence
when compared with wide excision for Campanacci’s Grade II-III of giant cell tumor of bone. Even better function was found
in extended curettage group, the choice of surgical treatment should be considered in individual patient which depends on the
extent of bone destruction and risk of tumor recurrence.
Keywords : Giant cell tumor, Knee, Extended curettage, Wide excision, Local recurrence
