This study is a retrospective review of 26 Campanacci Grade II (well-defined margins, but no radiopaque rim) and 37 Grade III (irregular borders suggesting a rapid and possibly permeative growth with extraosseous soft-tissue extension) giant cell tumors of bone in a cohort with an average age of 40 years (range, 19 -78 years) and an average follow up of 108 months (range, 25-259 months). There were 9 upper extremity lesions and 54 lower extremity lesions. Treatment included intralesional curettage and burring with adjuvant phenol and PMMA treated by the same surgeon. The local recurrence rate was 7.7 % in Grade II lesions and 5.4 % in Grade III lesions with an overall local recurrence rate of 6.3 %. Two were treated with repeat curettage, burring, phenol and PMMA while the other 2 had wide resection and reconstruction with insertion of a segmental replacement hinged knee arthroplasty. The mean range of motion and final follow-up was 97 % at the joint closest to the surgical intervention. There were no complications related to wound healing or the use of phenol and PMMA. Exclusion criteria included pathologic fractures including intraarticular fractures.
This data supports the use of intralesional curettage and burring with phenol and PMMA for giant cell tumors, even in the face of extraosseous extension with no added risk of recurrence with the regimen outlined above. Despite the common position of this lesion being periarticular and the theoretical risk of subchondral and cartilage damage with intralesional cytotoxic agents, there was only one case of degenerative arthrosis that developed postoperative in a patient with no sign of preoperative degenerative changes. An important oncologic principle in treating giant cell tumors of bone involves creating a large cortical window to “exteriorize” the lesion to allow for adequate resection.
Clinical Orthopaedics and Related Research