Total Synovectomy and Bone Grafting/Cementation after Curettage of the Bone Lesion in Diffuse‏ Type ‏of Tenosynovial‏ Giant Cell Tumor‎: A Retrospective Cohort Study

Abstract

Objectives: Although the diffuse type of tenosynovial giant cell tumor (D-TGCT) is rare, bone involvement is common in such lesions. However, the optimal management of bone lesions in D-TGCT is not well-described. In this study, we reported the outcomes of total synovectomy, curettage, and bone grafting/cementation in the treatment of D-TGCT with subchondral bone involvement. We also described the prevalence, demographic, and characteristic features of the lesions.

Methods: In a retrospective study, we included 13 patients with D-TGCT of large joints and associated subchondral cyst/cyst-like bone lesions of ≥ 5 mm that were managed with total synovectomy and curettage. Cavities with a bone defect of ≤ 30 mm (n=12) were filled with bone grafts. Cavities of > 30 mm (n=1) were augmented with bone cement. The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score.

Results: The study population consisted of 6 (46.1%) males and 7 (53.9%) females with a mean age of 30 ± 7.9 years. The most frequent sites of involvement were the knees and ankle joints (n=5 each, 38.5%). The mean follow-up of the patients was 69.2 ± 32.9 months. The mean MSTS score of the patients was obtained at 98.2 ± 3.2 (range 90-100). The D-TGCT recurred in two patients, both of which were in the synovium. Postoperative complications were three cases of transient pain and one case of knee joint stiffness. While no patient had an osteoarthritic change in preoperative radiographs, two patients had osteoarthritic change (grade II) in the last follow-up, one in the knee and one in the hip.

Conclusion: Curettage and filling the defect with bone graft or cement are adequate treatments for managing bone lesions in D-TGCT.

Keywords: Bone lesion; Curettage; Diffuse tenosynovial giant cell tumor; Pigmented villonodular synovitis.

Figure 1

Flow diagram of the study

Figure 2

(a) Preoperative anteroposterior hip radiograph of a 33-year-old male with D-TGCT and associated bone cyst in the ilium and femoral neck; (b) Coronal reconstruction CT scan showing the bone cyst in the ilium; (c) Coronal reconstruction CT scan showing the bone cyst in the femoral neck; (d) T2-weighted fact suppressed axial MRI showing the ischium defect (white arrow) before treatment by synovectomy, extended curettage, and bone grafting; (e) Anteroposterior hip radiograph of the four years after the operation showing grade II osteoarthritic change of the hip joint

Figure 3

Intraoperative photograph showing extended curettage through creating an extra-articular window in the proximal tibia; Black arrow is showing the lateral femoral condyle and white arrow is showing the patellar tendon

Figure 4

(a) Preoperative anteroposterior knee radiograph of a 40-year-old male with D-TGCT and an associated tibial bone cyst; (b) T1-weighted fact suppressed sagittal MRI showing a large bone defect in the proximal tibia; (c) Anteroposterior knee radiograph of three years after the treatment with synovectomy, extended curettage, and cementation