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Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study

International Orthopaedics volume 45, pages 289–297 (2021)Cite this article

Abstract

Purpose

For the treatment of giant cell tumour of the bone (GCTB) around the knee, preserving the native joint confers advantages over scarifying it. But, there is a controversy about the efficacy of intralesional curettage versus en bloc resection for treatment of such lesions. In this study, we compared local recurrence, functional outcomes, and complications of extended curettage and en bloc resection in these lesions.

Methods

Patients with grade 3 GCTB of the distal femur or proximal tibia who were presented with a pathologic fracture and treated with either en bloc resection (n = 22) or extended curettage (n = 20) were included. The mean follow-up of the patients was 6.4 ± 1.9 years in the resection group and 5.5 ± 2.4 years in the extended curettage group. The primary outcome was a local recurrence. Secondary outcomes were limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score and rate of complications.

Results

Local recurrence was seen in four (20%) patients of the curettage group and three (13.7%) patients of the resection group (P = 0.69). The mean MSTS score was 24 ± 1.9 in the resection group and 26.5 ± 1.3 in the curettage group (P < 0.001). The number of complications was not significantly different between the two study groups (P = 0.49). However, the number of complications that required revision surgery was significantly more in the resection group (P = 0.049).

Conclusion

In grade 3 GCTB around the knee with pathologic fracture, extended curettage results in comparable oncologic outcomes to en bloc resection, while providing better function and a lower rate of revision.

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Affiliations

  1. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

    Khodamorad Jamshidi, Farshad Zandrahimi, Milad Haji Agha Bozorgi, Amir Mohammad Arefpour, Abolfazl Bagherifard & Alireza Mirzaei

  2. College of Medicine, University of Al-Kufa, Kufa, Najaf, Iraq

    Hamadalla Hadi Al-Baseesee

Authors
  1. Khodamorad Jamshidi
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  2. Farshad Zandrahimi
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  3. Milad Haji Agha Bozorgi
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  4. Amir Mohammad Arefpour
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  5. Abolfazl Bagherifard
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  6. Hamadalla Hadi Al-Baseesee
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  7. Alireza Mirzaei
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Corresponding author

Correspondence to Alireza Mirzaei.

Ethics declarations

This retrospective cohort study was approved by the review board of our institute under the code of IR.IUMS.REC.1399.468. The patients provided written consent to use their medical data for publication.

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The authors of declare that they have no conflict of interest.

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Jamshidi, K., Zandrahimi, F., Haji Agha Bozorgi, M. et al. Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study. International Orthopaedics (SICOT) 45, 289–297 (2021). https://doi.org/10.1007/s00264-020-04836-y

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  • DOI: https://doi.org/10.1007/s00264-020-04836-y

Keywords

  • Giant cell tumour
  • Pathologic fracture
  • Extended curettage
  • En bloc resection