Joint Preservation after Extensive Curettage of Knee Giant Cell Tumors (original) (raw)
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Functional Outcome of Extended Curettage and Reconstruction for Giant Cell Tumor around Knee
2021
Background: GCT Bone is the commonest benign bone tumor with female predominance and commonly seen around knee joint. Treatment of GCT can be done by curettage with reconstruction or wide resection. The aim of this study is to see functional outcome of extended curettage and reconstruction with bone cement or sandwich technique along with internal fixation. Method: A total of 9 females and 6 males aged between 20-50 years managed with extended curettage and reconstruction with bone cement(6) or sandwich technique(9). Along with internal fixation in all patients except two patients (small lesion less than 5cm) between January 2015 to December 2020 were taken. Extended curettage was done with the help of 5% phenol and high speed burr. Functional outcome was evaluated using Musculoskeletal tumor society score (MSTS). Results: The mean follow up period was 20.13 months (range 12-48 months). The mean MSTS score at final follow up was 25.27 out of 30. Age, sex did not have much effect on ...
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...
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...
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.
Resection arthrodesis for giant cell tumors around the knee
Indian Journal of Orthopaedics, 2007
Background: Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent and extensive tumors. As the patients affected with GCT are young or middle-aged adults with a normal life expectancy, arthrodesis is an attractive option for reconstruction in these patients. Materials and Methods: Thirty-six patients of mean age 33.1 years with Campanacci Grade III giant cell tumors around the knee (20 distal femoral and 16 proximal tibial) were treated with wide resection and arthrodesis from January 1996 through January 2006. Arthrodesis was performed using plating with free fibular graft (n = 18), IM nail with free fibular graft (n = 8) and IM nail combined with ring fixator using bone transport (n = 10). Results: Fusion after the first surgery was achieved in 77.7%, 75% and 90% of the patients in the three groups respectively. Local recurrence was seen in two patients and repeat surgery for nonunion/ graft fracture had to be done in four patients and two patients in the plating and nailing groups respectively. Conclusion: Wide resection and arthrodesis in aggressive GCTs around the knee is a good treatment option. IM nail combined with a ring fixator seems to be a good method of arthrodesis with high fusion rates, least shortening and early rehabilitation.
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.
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...
Case reports in orthopedics, 2015
We present a case of knee reconstruction 20 years after treatment of a giant cell tumor (GCT) with curettage and cementation. There is currently an ongoing debate whether cement or allograft bone is the preferred material for filling the void after GCT curettage. In this case we were able to readily implant a primary total knee replacement without disturbing the existing well-interdigitated large cement bolus and did not require any stems or augments for the reconstruction. Given the ease of TKR implantation in this patient, we feel that the use of cement following curettage of a GCT lesion is a better choice than allograft bone which may not provide enough structural support for the knee reconstruction and lead to a much more extensive procedure.
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...