Comparative Analysis of Two Surgical Treatment Options for Giant Cell Tumor of the Proximal Femur: Extended Curettage and Segmental Resection

AimAs a locally destructive intermediate bone tumor with low incidence, high recurrence rate, and difficulty in reconstruction, giant cell tumor of bone (GCTB) in the proximal femur has no unified surgical treatment standard. This study aimed to compare the differences in local recurrence, reconstruction durability, and postoperative function after treatment with either extended curettage (EC) or segmental resection (SR) for GCTB in the proximal femur so as to provide constructive suggestions for the rational selection of EC or SR operation scheme.Patients and Methods29 patients (15 men and 14 women) were included in this retrospective study, with a mean age of 32.1 years. According to the division method of proximal femur of International Society Of Limb Salvage (ISOLS), there was 1 case in the H1 area, 17 cases in the H2 area, 10 cases in the H1+H2 area, and 1 case in the H1+H2+H3 area. Among them were 11 cases of Campanacci grade II GCTB, 18 cases of Campanacci grade III GCTB, and 7 cases with pathological fractures. All patients underwent either EC or SR surgery. The Musculoskeletal Tumor Society (MSTS) score was used for patient evaluation. The operation effectiveness was analyzed according to the Mankin evaluation standard. Regular follow-up was performed to evaluate the recurrence rate, limb function, and long-term complications of the two surgical methods.ResultsAll patients were followed up for a mean of 60.4 months. Local recurrence occurred in one of 19 patients treated with EC (5.3%) and one of 10 patients treated with SR (10%). The MSTS score of lower limb function in patients in the EC group was better compared to patients in the SR group (P = 0.002). Complications occurred in 2 cases (10.5%) and 5 cases (50%) in the EC group (osteoarthritis, osteonecrosis) and SR group (joint stiffness, infection, prosthesis loosening), respectively, with significant differences between the two groups (P = 0.03). The operation effectiveness was analyzed according to the Mankin evaluation standard. The EC group showed an optimal rate of 94.7% (18/19) as opposed to 80% (8/10) in the SR group.ConclusionsFor GCTB in the proximal femur, when the tumor does not extensively involves the surrounding soft tissues, the articular surface was not damaged, and there is no pathological fracture with apparent displacement, EC surgery should be fully considered.

Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage

Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA (< 2 mm), and DPC were significantly related to recurrence, as determined by multivariate logistic regression. The C-index of the final model was 0.79 (95% CI: 0.71 to 0.88), representing a good model for predicting recurrence. Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage.

1125 Proximal Tibial Giant Cell Tumor in A 25-Year-Old Female Treated with Two Stage Extended Curettage, Cementing and Arthrodesis. Key Words: GCT, Two Stage, Curettage, Cementation, Arthrodesis

Introduction Giant cell tumor of bone is a benign but locally aggressive tumor accounting for approximately 20% of benign osseous neoplasms. Female gender predominance, common in second to third decade of life. Commonly seen around knee, with the distal femur being more frequently involved. Method Presenting a 25year old lady with history of progressive pain and swelling around right knee for 2 years and inability to walk for 6 months. Radiography and biopsy revealed giant cell tumor of the right proximal tibia involving the medial condyle. Two staged procedure planned. Stage 1 extended curettage, cementation of cavity with PMMA and a knee spanning fixator was done. In stage 2 at 12 weeks cement was removed and knee arthrodesis using allograft performed retaining the fixator in place. Results Patient was able to partially bear weight 6 weeks post 2nd stage of surgery and was able to bear full weight after 12 weeks. A solid arthrodesis was achieved at 5 months post 2nd stage, when the fixator was removed. There is no recurrence at end of one year Conclusions This is a novel method of low-cost treatment using bone cement and external fixator for stability. Cement gives immediate structural support and fixator allows ambulation and early weight-bearing. The importance of thorough curettage cannot be overemphasized in preventing recurrence. This can be a viable alternative treatment option for patients presenting with large giant cell tumors around the knee joint who cannot afford options like wide local excision and joint replacement using mega-prosthesis.

Chondroblastoma of the Acromion: A Case Report and Review of the Literature

Chondroblastomas are rare benign neoplasms and scarcely present in the acromion. We reported a case of chondroblastoma presented in the right acromion of a 36-year-old male. The patient had pain and restricted abduction. Moreover, the histological analysis of the biopsy sample was consistent with the diagnosis of chondroblastoma. The patient was treated with extended curettage and bone grafting. Besides, the 2-year follow-up of the patient was event-free. This case reveals that the chondroblastoma of acromion can be adequately treated by extended curettage. It also highlights the importance of acromion chondroblastoma in the differential diagnosis of shoulder pain to avoid the undertreatment of the patients.