Iterative curettage is associated with local control in giant cell tumors involving the distal tibia

Abstract

Background: The distal tibia is an unusual location for a giant cell tumor (GCT). Treatment choices are unclear because of their rarity, the anatomy of the ankle, and difficulties associated with reconstruction.

Questions/purposes: We assessed: (1) the treatment modalities used by participating Canadian bone tumor centers for distal tibia GCTs; (2) the incidence of local recurrence and their management; and (3) patients' function after treatment.

Methods: A prospective tumor database served to identify all 31 patients with primarily treated distal tibia GCTs between 1991 and 2010. We extracted patients and tumor characteristics, treatment modalities for initial and recurrent tumors, and the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage (TESS) scores. The median followup was 58 months (range, 24-192 months).

Results: Extended curettage was the only modality of treatment for all patients including all subsequent local recurrences. Nine had local recurrence, three of which had a second local recurrence; one had a third recurrence. Ultimately all patients were in remission at last followup. The local recurrence rate was 29% and appeared higher compared with recent series of all anatomic sites. The mean final MSTS and TESS scores were 91% (range, 71%-100%) and 88% (range, 35%-100%), respectively.

Conclusions: Extended curettage was the unique modality of surgical treatment for all tumors. We found the incidence of local recurrence higher than that reported for other locations but recurrences were manageable with repeated curettage. Complications and function appeared better than those reported for series of ankle fusion or reconstruction for bone tumors.

Fig. 1A–D

(A) AP and (B) lateral plain radiographs of the left ankle of a 28-year-old woman show a lytic and expansile lesion in the lateral aspect of the distal tibia. A biopsy confirmed it as a benign giant cell tumor. (C) Axial and (D) coronal CT scans of the same patient show the extent of the tumor and involvement of the subchondral area.

Fig. 2A–C

Five-year followup (A) AP and (B) lateral plain radiographs of the ankle of the same patient are shown. A local recurrence occurred 2.5 years earlier and was treated similar to the initial tumor. (C) A coronal MR image shows the local recurrence in the distal and lateral edges of the tibia.