Functional Outcome of Extended Curettage and Reconstruction for Giant Cell Tumor around Knee (original) (raw)
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Giant Cell Tumors (GCT) Around Knee- Curettage and Reconstruction by Ilizarov Technique
MOJ Orthopedics & Rheumatology, 2015
Purpose: To evaluate outcomes of 17 patients who underwent curettage, use of phenol and reconstruction using the llizarov technique for giant cell tumors (GCT) of bone around the knee. Methods: 12 men and 5 women aged 18 to 45 (mean 26) years underwent intralesional curettage, use of phenol, and reconstruction using the Ilizarov technique for GCT of the proximal tibia (n=14) or distal femur (n=3), 5 of the cases were recurrence. 3, 12 and 2 tumors were classified as grade-I, grade-II and grade-Ill, respectively. One of the grade-III tumors was associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol and reconstruction by Ilizarov technique. 1,2 Functional outcome was evaluated using the Musculo skeletal tumor society (MSTS) score. Results: The mean follow up period was 6 (2.5-10) years. The mean MSTS score was 28.5 out of 15 (Standard deviation, 3; range, 15-30. No patient had malignant transformation. Conclusion: Intralesional curettage use of phenol and reconstruction with llizarov for GCT of bone achieved good functional outcome and no recurrence rate.
Journal of Orthopaedics and Traumatology
Background Giant cell tumor of bone (GCTB) is a benign locally aggressive tumor frequently treated with intralesional curettage and cementation. The aim of this study was to investigate the long-term incidence of arthritic changes following curettage and cementation of GCTB around the knee. Materials and methods This study was a retrospective review of patients with GCTB around the knee treated with curettage and cementation with a minimum follow-up of 10 years. The functional results were assessed using the Musculoskeletal Tumor Society (MSTS) score. The arthritic changes were classified using the Kellgren–Lawrence (KL) classification system of osteoarthritis. Results This study included 119 patients, 54 males and 65 females, with a mean age of 29.4 ± 9.2 years. There were 35 (29.4%) patients with pathological fractures. There were 84 (70.6%) patients with de novo lesions and 35 (29.4%) with recurrent lesions. The mean follow-up period was 13.2 ± 3.16 years. The mean MSTS score was...
Curettage and reconstruction by the sandwich technique for giant cell tumours around the knee
Journal of orthopaedic surgery (Hong Kong), 2014
To evaluate outcomes of 36 patients who underwent curettage, use of phenol, and reconstruction using the sandwich technique for giant cell tumour (GCT) of bone around the knee. 22 women and 14 men aged 19 to 46 (mean, 29.6) years underwent intralesional curettage, use of phenol, and reconstruction using the sandwich technique for GCT of the proximal tibia (n=23) or distal femur (n=13). Two of the cases were recurrences. Two, 18, and 16 tumours were classified as grade I, grade II, and grade III, respectively. Five of the grade III tumours were associated with an extra-articular pathological fracture. Patients underwent intralesional curettage, use of phenol, and reconstruction with allograft, gel foam, and cement (the sandwich technique). Pathological fractures were fixed with plates. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up period was 5 (2.5-11) years. The mean MSTS score was 27.7 out of 30 (standard deviation, 3; ran...
Joint Preservation after Extensive Curettage of Knee Giant Cell Tumors
Clinical Orthopaedics and Related Research®, 2009
Curettage is the most attractive procedure for surgically treating a giant cell tumor because it preserves joint function. However, since many giant cell tumors compromise subchondral bone this technique can jeopardize the articular surface with subsequent fractures or collapse. We asked whether intralesional curettage of a giant cell tumor close to the knee that combined morselized bone and cortical structural allograft would preserve joint function. We retrospectively reviewed 22 patients treated with that approach. The minimum followup was 2 years (average, 48 months; range, 24-80 months). The distal femur was involved in 12 patients and proximal tibia in 10. Complications and failures were recorded and functional results evaluated with Musculoskeletal Tumor Society score. We determined survivorship using the Kaplan-Meier technique using removal of the implant as the endpoint. The survival was 85% and the average functional score 28 points.
Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee
SICOT-J
Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 pat...
EFORT Open Reviews
Giant cell tumour of bone (GCT) is a relatively rare, locally aggressive benign neoplasm observed in the long bone epiphyseal-metaphyseal regions of young adults. The optimal treatment strategy for these tumours remains controversial, and a huge amount of contradictory data regarding the functional and oncological outcomes can be found. Therefore, we performed a systematic review intended to investigate the functional and oncological outcomes after surgical treatment of GCTs arising around the knee, namely in the distal femur and proximal tibia. A trend towards better oncological control was found using wide resections, nonetheless, curettage-based techniques achieve a highly acceptable recurrence rate with overall better knee function. A slight advantage favouring proximal tibia GCTs regarding the Musculoskeletal Tumor Society (MSTS) score was also observed. Prospective studies comparing groups of more homogeneous patients, tumours, and treatment options should be developed to obta...
Treatment of giant cell tumours of bone by radical curettage and bone cement
International Journal of Research in Medical Sciences
Background: Giant cell tumour of bone remains a difficult and challenging management problems because there are no absolute clinical radiographic or histologic parameters that accurately predict the tendency of any single lesion to recur or metastasize.Methods: We performed surgery on 12 patients of GCT with radical curettage and bone cement over a period of 5.8 years. Results were evaluated using the musculoskeletal skeletal grading system.Results: The present series consists of 12 case of GCT age ranging from 16-45 years. Painful swelling was the commonest presentation, limitation of motion was seen in 9 cases and pathological fracture was seen in 1 case. 9 of the tumour occurred around knee joint. Rare involvement of talus was seen in 1 case. Overall 9 patients had a perfect functional score of 30 points and 1 patient scored less than 20 points.Conclusions: Acrylic cement reconstruction is safe and effective procedure that provides local adjuvant therapy, the cement field defect ...
Giant cell tumor locally advanced around the knee: treatment and literature review
Revista Brasileira de Ortopedia (English Edition), 2017
Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics. They are more prevalent in the third decade of life and demonstrate a preference for locating in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. The risk of lung metastases is around 3%. Between October 2010 and August 2014, nine patients diagnosed with locally advanced GCT or with pathological fracture to the knee level underwent surgical treatment. The aim of this study was to evaluate the results of the treatment, particularly with regard to relapse, and to conduct a literature review. There was a predominance of males (77.7%). The most common location was the distal femur. Four patients (44%) developed local recurrence in the first year after surgery, three in distal femur and one in proximal tibia. Of the two patients with pathologic fracture at diagnosis, one of them presented recurrence after five months. The treatment of GCT is still a challenge. The authors believe that the best treatment method is wide resection and reconstruction of bone defects with non-conventional endoprostheses. Patients should be aware and well informed about the possible complications and functional losses that may occur as a result of the surgical treatment chosen and the need for further surgery in the medium and long term.
HSS Journal, 2009
Giant cell tumors are neoplasms of mesenchymal stromal cells with varied manifestations. There is no uniform accepted treatment protocol for these tumors. Curettage, although an accepted method of treatment, carries a high local recurrence rate. Adjuvant therapies including high-speed burr debridement, cryotherapy, and phenol treatment have been advocated to reduce local recurrence. We have used these adjuvants to determine if improved cure rate with improved outcomes could be attained with regard to local tumor control and functional outcome. Twenty-eight cases of proven giant cell tumors of the distal femur and proximal tibia were included in this prospective case series. The lesions were at the upper tibia in 14 cases and the lower femur in 14 patients. The patients were evaluated clinically, radiologically, and by histological examination. Companacci grading and Enneking staging were determined. The treatment was done in the following steps: Curettage and further debridement with a high-speed burr, cryotherapy, impaction of the cavity with subchondral iliac crest bone graft, and, finally, cementation with or without internal fixation. Functional evaluation was done by Enneking's system. The follow-up time was between 24-40 months with a mean of 34 months. The functional results of the procedure were rated as good to excellent with a mean of 93.9%. This technique has the advantages of joint preservation, excellent functional outcome, and low recurrence rate when compared with other treatment modalities. For these reasons, it is recommended as an adjuvant to curettage for most giant cell tumors of bone.
Clinical Outcomes of Grade 3 Giant Cell Tumor of Bone After Extended Intralesional Curettage
Journal of Orthopedic Oncology, 2017
Introduction: The recommended treatment of grade 3 giant cell tumor of bone (grade 3 GCTB) aims to eliminate tumor and conserve limb with extended intralesional curettage. This treatment makes patients better function of bone and joint as usual. Even it can reduce postoperative complications and replace endoprosthesis. Still, there is limited information about the outcomes of surgical treatment and recurrence of the disease. This study aimed to evaluate the clinical outcomes and recurrence of grade 3 GCTB with extended intralesional curettage. Case Description: This study performed a retrospective review of 26 consecutive patients with grade 3 GCTB treated by extended intralesional curettage at Khon Kaen hospital from June 2012 to May 2017. Clinical outcomes including, functional analysis according to Musculoskeletal Tumor Society functional classification (MSTS score), pain score, postoperative complication and recurrence rate were evaluated. Twenty out of twenty-six patients were motion as usual within 6 months after surgery while recurrence of the disease is shown only one case. However, postoperative complications have not yet been reported. Conclusion: The extended intralesional curettage of grade 3 GCTB grade is an effective treatment. Nevertheless, it have to keep recall the patient for detection of disease recurrence. Journal of Orthopedic Oncology Journ a l o f O rt hoped ic O n c ol ogy