Outcome of Surgical Treatment of Giant Cell Tumors of Bone Around the Knee Joint for Extended Curettage or Segmental Resection: A Retrospective Study

Abstract

Background Giant cell tumors (GCTs) of bone around the knee are locally aggressive benign neoplasms with a tendency for recurrence and functional compromise. Surgical options include extended curettage (EC), often combined with adjuvants and internal fixation (sandwich technique), or segmental resection (SR) with megaprosthesis reconstruction. The optimal approach remains debated. This study compares oncological and functional outcomes between these two surgical strategies in a cohort of 65 patients. Methods A retrospective analysis was conducted at the Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, over six years. Patients with biopsy-confirmed GCTs around the knee who underwent EC or SR were included. Outcomes assessed included local recurrence, recurrence-free survival (RFS), Musculoskeletal Tumor Society (MSTS) scores, operative time, blood loss, hospital stay, and postoperative complications. Results Of the 65 patients (EC: 48; SR: 17), local recurrence was noted in 12.5% of the EC group and 5.9% of the SR group (p=0.762). For Grade II tumors, recurrence occurred in 4.2% of EC cases and none in SR; for Grade III tumors, recurrence rates were 8.3% (EC) and 5.9% (SR). At three years, RFS was 87.5% for EC and 94.1% for SR (p=0.604). SR involved longer surgeries (172.7 ± 36.3 vs. 119.2 ± 23.8 min, p<0.001), greater blood loss (656.8 ± 155.6 vs. 319.6 ± 127.9 mL, p<0.001), and longer hospital stays. EC demonstrated superior functional outcomes (MSTS: 25.5 ± 3.2 vs. 22.1 ± 3.8, p=0.007). Complication rates were higher in SR (35.3%) compared to EC (20.8%), though not statistically significant (p=0.268). Conclusion EC offers superior functional outcomes with a non-significant trend toward higher recurrence, whereas SR provides better local control at the cost of greater surgical morbidity. These findings suggest that patient selection should consider tumor grade, extent, and individual functional priorities. Prospective studies are needed to refine treatment algorithms and optimize outcomes.

Keywords: extended curettage; giant cell tumor; msts score; recurrence; segmental resection.

Figure 1. Extended Curettage (EC) in a 32-year-old male. (A) Preoperative X-ray of right proximal tibia showing giant cell tumor (GCT); (B) Intraoperative image depicting iliac crest graft, fibular bone graft, and artificial bone substitute; (C) Bone cement; (D) Postoperative X-ray of the right knee; (E) Four-year follow-up X-ray demonstrating new bone formation at the subarticular surface of the right proximal tibia

Figure 2. Segmental resection (SR) in a 45-year-old female. (A) Preoperative X-ray of the right distal femur showing giant cell tumor (GCT); (B) X-ray at three months postoperatively; (C) X-ray at three-year follow-up; (D) Preoperative clinical photograph surgical view of the right lower limb; (E) Exposed tumor; (F) Resected distal femur with tumor; (G) Bone gap following resection; (H) Bone gap reconstructed using a hinge knee mega prosthesis

Figure 3. Kaplan-Meier curve for recurrence-free survival in extended curettage and segmental resection

Figure 4. Clinical decision-making flowchart for surgical management of giant cell tumors around the knee