A Tertiary Care Centre Experience of Recurrent Giant Cell Tumor Around the Knee Joint

Abstract

Introduction: Giant cell tumor (GCT) is a benign but locally aggressive bone tumor. It has a peak incidence between 30-40 years with a predilection for the epiphyseal/metaphyseal region of bone. The most common locations for bone GCT are the distal femur, proximal tibia, distal radius, and sacrum in decreasing order.

Material and methods: In this retrospective study, 22 patients (13 females and nine males) with recurrent giant cell tumors around the knee joint between 2009-2022, with a mean age of 30.2 years (range: 18-55) were included. The patients were followed up monthly for three months, three-monthly for the next two years, six-monthly for the next five years, and thereafter, yearly. The mean follow-up period was 36.97 months (range 23-120 months).

Results: There were 19 recurrences after curettages and three after resections. Re-extended curettage was done in 17 cases and the resultant cavities were filled with autologous bone grafts in six and with polymethyl methacrylate (PMMA) cement in the other 11 cases. Reconstruction with megaprosthesis was done in two patients whereas knee arthrodesis was done in two patients after wide resection. The average Musculoskeletal Tumor Society (MSTS) score of our series of 22 patients was 23.1 (Range: 19-30).

Conclusion: Campanacci grade 1 and 2 lesions can be successfully treated with extended curettage and bone grafting/bone cementing. For patients with grade 3 lesions, there are two options available according to the financial status of the patient; the first option is reconstruction with prosthesis and the other option is arthrodesis.

Keywords: bone tumors; extended curettage; gct recurrence; knee arthrodesis; mega prosthesis.

Figure 1. Recurrent GCT of distal femur in a 31-year-old male treated with extended curettage and bone cementing: (A) Preoperative radiograph showing recurrent GCT in distal femur; (B) Cavity after extended curettage; (C) Cavity filled with bone cement; (D) Postoperative radiograph showing extended curettage with bone cementing; (E) Follow-up radiograph after six months; (F) Functional outcome

GCT: giant cell tumor

Figure 2. A female patient aged 24 years with distal femur GCT recurrence, which was treated with resection and megaprosthesis: (A) Preoperative radiograph showing extended curettage and bone grafting; (B) Intraoperative image showing involved area; (C) Intraoperative image showing megaprosthesis; (D) Resected specimen; (E) postoperative radiographs showing megaprosthesis; (F) Histological image of recurrent GCT (H&E stain)

GCT: giant cell tumor;  H&E: hematoxylin & eosin

Figure 3. Recurrent GCT of proximal tibia in a 24-year-old male who was treated with extended curettage and bone cementing: (A) Preoperative radiograph showing recurrent GCT in proximal tibia; (B) Postoperative radiograph showing extended curettage with bone cementing; (C) Follow-up radiograph after six months; (D) Functional outcome

GCT: giant cell tumor

Figure 4. Various treatment modalities

EC: extended curettage; BG: bone grafting; BC: bone cement

Figure 5. Treatment guidelines for patients with recurrent GCT around knee

Image credits: Mohit Singla GCT: giant cell tumor