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J Knee Surg 2023; 36(12): 1218-1223
DOI: 10.1055/s-0042-1750749
Original Article

Total Knee Arthroplasty for Osteoarthritis Is Uncommon after Intralesional Curettage in Giant Cell Tumor of Bone

Linus Lee
1   Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
,
Neil Buac
1   Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
,
Matthew W. Colman
1   Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
,
Steven Gitelis
1   Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
,
Alan T. Blank
1   Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
› Author Affiliations Funding None.
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Abstract

Giant cell tumor of bone (GCTB) is most often treated with intralesional curettage; however, periarticular lesions have been shown to increase risk for osteoarthritis. Additionally, the location of these lesions may occasionally preclude a joint-sparing procedure in recurrent tumors. This study sought to investigate rates of secondary arthroplasty in long-term follow-up of knee GCTB. Cases of knee GCTB treated at our institution were reviewed. Rates of recurrence and secondary arthroplasty were recorded, and Kaplan-Meier survival analyses were performed. The records of 40 patients were reviewed. Local recurrence occurred in 25% of patients. The 1-, 5-, and 10-year recurrence-free survival (RFS) probability was 87.4% (95% CI, 77.0–97.7), 72.4% (95% CI, 57.6–87.2), and 72.4% (95% CI, 57.6–87.2), respectively. Function improved after surgery with a mean preoperative MSTS score of 14.9 (standard deviation [SD] 8.4) and mean postoperative MSTS score of 25.1 (SD 5.6) (p <0.001). Three patients had evidence of radiographic osteoarthritis at the last follow-up though they did not require arthroplasty. Arthroplasty was performed as a secondary procedure in six patients. Five patients underwent arthroplasty for recurrent tumors after initial treatment with curettage and one patient underwent patellar arthroplasty for osteoarthritis after initial treatment with an allograft composite arthroplasty. Arthroplasty is performed as a secondary procedure in patients with GCTB at a relatively infrequent rate and more often for cases of recurrent disease than for osteoarthritis. Overall, patients treated for GCTB have improved functional outcomes after surgery than before. Large, multi-institutional studies may be required to assess the incidence of secondary osteoarthritis requiring arthroplasty as this was an infrequent finding in our cohort.

Keywords

giant cell tumor of bone - intralesional curettage - arthroplasty - polymethyl methacrylate

Authors' Contributions

L.L. contributed toward data collection, analysis, interpretation, drafting, editing, and revisions. N.B. did the data collection, interpretation, drafting, editing, and revisions. M.W.C. and S.G. contributed toward oversight, editing, and revisions. A.T.B. worked toward conception, oversight, editing, and revisions.


Ethical Approval

Rush University Medical Center obtained individual Institutional Review Board approval prior to beginning any research efforts.


Availability of Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.




Publication History

Received: 16 February 2022

Accepted: 26 April 2022

Article published online:
28 July 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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  • References

  • 1 Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ. Giant cell tumor of bone. J Am Acad Orthop Surg 2013; 21 (02) 118-126
    CrossrefPubMedGoogle Scholar
  • 2 Gitelis S, Mallin BA, Piasecki P, Turner F. Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am 1993; 75 (11) 1648-1655
    CrossrefPubMedGoogle Scholar
  • 3 Jones NF, Graham DJ. Radical resection of a recurrent giant cell tumor of the distal ulna and immediate reconstruction with a distal radio-ulnar joint implant arthroplasty. Hand (N Y) 2020; 15 (05) 727-731
    CrossrefPubMedGoogle Scholar
  • 4 Gulia A, Puri A, Prajapati A, Kurisunkal V. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma 2019; 10 (06) 1033-1037
    CrossrefPubMedGoogle Scholar
  • 5 Barik S, Jain A, Ahmad S, Singh V. Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: a case series. Eur J Orthop Surg Traumatol 2020; 30 (06) 1109-1117
    CrossrefPubMedGoogle Scholar
  • 6 Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 2011; 469 (02) 591-599
    CrossrefPubMedGoogle Scholar
  • 7 Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res 2011; 469 (04) 1181-1187
    CrossrefPubMedGoogle Scholar
  • 8 Vult von Steyern F, Bauer HCF, Trovik C. et al; Scandinavian Sarcoma Group. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Joint Surg Br 2006; 88 (04) 531-535
    CrossrefPubMedGoogle Scholar
  • 9 Balke M, Ahrens H, Streitbuerger A. et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol 2009; 135 (01) 149-158
    CrossrefPubMedGoogle Scholar
  • 10 Orr A, Liu H, Mariani R, Aldrink JH, Setty BA, Koo S. Bilateral lung metastases from a phalangeal giant cell tumor of bone. Pediatr Dev Pathol 2021; 24 (01) 51-55
    CrossrefPubMedGoogle Scholar
  • 11 van der Heijden L, van de Sande MAJ, Heineken AC, Fiocco M, Nelissen RGHH, Dijkstra PDS. Mid-term outcome after curettage with polymethylmethacrylate for giant cell tumor around the knee: higher risk of radiographic osteoarthritis?. J Bone Joint Surg Am 2013; 95 (21) e159
    CrossrefPubMedGoogle Scholar
  • 12 Caubère A, Harrosch S, Fioravanti M, Curvale G, Rochwerger A, Mattei JC. Does curettage-cement packing for treating giant cell tumors at the knee lead to osteoarthritis?. Orthop Traumatol Surg Res 2017; 103 (07) 1075-1079
    CrossrefPubMedGoogle Scholar
  • 13 Suzuki Y, Nishida Y, Yamada Y. et al. Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone. Knee 2007; 14 (05) 369-374
    CrossrefPubMedGoogle Scholar
  • 14 Benevenia J, Rivero SM, Moore J. et al. Supplemental bone grafting in giant cell tumor of the extremity reduces nononcologic complications. Clin Orthop Relat Res 2017; 475 (03) 776-783
    CrossrefPubMedGoogle Scholar
  • 15 Xu H, Zhang M, Zhai G, Li B. The clinical significance of 18F-FDG-PET/CT in early detection of second primary malignancy in cancer patients. J Cancer Res Clin Oncol 2010; 136 (08) 1125-1134
    CrossrefPubMedGoogle Scholar
  • 16 Araki Y, Yamamoto N, Hayashi K. et al. Secondary osteoarthritis after curettage and calcium phosphate cementing for giant-cell tumor of bone around the knee joint. JBJS Open Access 2020; 5 (03) e19.00068
    CrossrefPubMedGoogle Scholar
  • 17 Kito M, Matsumoto S, Ae K. et al. Giant cell tumor of the distal femur: outcome beyond 20 years of follow-up after curettage with polymethylmethacrylate. J Orthop Sci 2018; 23 (06) 1051-1055
    CrossrefPubMedGoogle Scholar
  • 18 Qu H, Guo W, Li D, Yang Y, Wei R, Xu J. Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius. J Hand Surg Eur Vol 2019; 44 (04) 394-401
    CrossrefPubMedGoogle Scholar
  • 19 Fraquet N, Faizon G, Rosset P, Phillipeau JM, Waast D, Gouin F. Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res 2009; 95 (06) 402-406
    CrossrefPubMedGoogle Scholar
  • 20 Errani C, Ruggieri P, Asenzio MAN. et al. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 2010; 36 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 21 Chen TH, Su YP, Chen WM. Giant cell tumors of the knee: subchondral bone integrity affects the outcome. Int Orthop 2005; 29 (01) 30-34
    CrossrefPubMedGoogle Scholar