Outcome of Surgical Treatment of Giant Cell Tumors of Bone Around the Knee Joint for Extended Curettage or Segmental Resection: A Retrospective Study

TL;DR

This study compares two surgical treatments for bone tumors near the knee, finding that one method offers better function while the other reduces recurrence risk.

Contribution

The study provides a comparative analysis of extended curettage and segmental resection for giant cell tumors around the knee, focusing on recurrence and functional outcomes.

Findings

Extended curettage showed better functional outcomes but a non-significant trend toward higher recurrence rates.

Segmental resection resulted in longer surgeries, more blood loss, and higher complication rates.

Recurrence-free survival was slightly better with segmental resection but not statistically significant.

Abstract

Background

Giant cell tumors (GCTs) of bone around the knee are locally aggressive benign neoplasms with a tendency for recurrence and functional compromise. Surgical options include extended curettage (EC), often combined with adjuvants and internal fixation (sandwich technique), or segmental resection (SR) with megaprosthesis reconstruction. The optimal approach remains debated. This study compares oncological and functional outcomes between these two surgical strategies in a cohort of 65 patients.

Methods

A retrospective analysis was conducted at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, over six years. Patients with biopsy-confirmed GCTs around the knee who underwent EC or SR were included. Outcomes assessed included local recurrence, recurrence-free survival (RFS), Musculoskeletal Tumor Society (MSTS) scores, operative time, blood loss, hospital stay, and postoperative complications.

Results

Of the 65 patients (EC: 48; SR: 17), local recurrence was noted in 12.5% of the EC group and 5.9% of the SR group (p=0.762). For Grade II tumors, recurrence occurred in 4.2% of EC cases and none in SR; for Grade III tumors, recurrence rates were 8.3% (EC) and 5.9% (SR). At three years, RFS was 87.5% for EC and 94.1% for SR (p=0.604). SR involved longer surgeries (172.7 ± 36.3 vs. 119.2 ± 23.8 min, p<0.001), greater blood loss (656.8 ± 155.6 vs. 319.6 ± 127.9 mL, p<0.001), and longer hospital stays. EC demonstrated superior functional outcomes (MSTS: 25.5 ± 3.2 vs. 22.1 ± 3.8, p=0.007). Complication rates were higher in SR (35.3%) compared to EC (20.8%), though not statistically significant (p=0.268).

Conclusion

EC offers superior functional outcomes with a non-significant trend toward higher recurrence, whereas SR provides better local control at the cost of greater surgical morbidity. These findings suggest that patient selection should consider tumor grade, extent, and individual functional priorities. Prospective studies are needed to refine treatment algorithms and optimize outcomes.

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