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Giant Cell Tumor With Pathologic Fracture: Should We Curette or Resect?

  • Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China
  • Published:
Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 02 October 2012

Abstract

Background

Approximately one in five patients with giant cell tumor of bone presents with a pathologic fracture. However, recurrence rates after resection or curettage differ substantially in the literature and it is unclear when curettage is reasonable after fracture.

Questions/Purposes

We therefore determined: (1) local recurrence rates after curettage with adjuvants or en bloc resection; (2) complication rates after both surgical techniques and whether fracture healing occurred after curettage with adjuvants; and (3) function after both treatment modalities for giant cell tumor of bone with a pathologic fracture.

Methods

We retrospectively reviewed 48 patients with fracture from among 422 patients treated between 1981 and 2009. The primary treatment was resection in 25 and curettage with adjuvants in 23 patients. Minimum followup was 27 months (mean, 101 months; range, 27–293 months).

Results

Recurrence rate was higher after curettage with adjuvants when compared with resection (30% versus 0%). Recurrence risk appears higher with soft tissue extension. The complication rate was lower after curettage with adjuvants when compared with resection (4% versus 16%) and included aseptic loosening of prosthesis, allograft failure, and pseudoarthrosis. Tumor and fracture characteristics did not increase complication risk. Fracture healing occurred in 24 of 25 patients. Mean Musculoskeletal Tumor Society score was higher after curettage with adjuvants (mean, 28; range, 23–30; n = 18) when compared with resection (mean, 25; range, 13–30; n = 25).

Conclusions

Our observations suggest curettage with adjuvants is a reasonable option for giant cell tumor of bone with pathologic fractures. Resection should be considered with soft tissue extension, fracture through a local recurrence, or when structural integrity cannot be regained after reconstruction.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Massimiliano Ippolito MD, PhD, orthopaedic surgeon, for his assistance in collecting data from patient records. We also thank Antonie H. M. Taminiau MD, PhD, and Rodolfo Capanna MD, PhD, who are both professors of orthopaedic oncology and surgically treated the majority of the patients.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, PO Box 9600, 2300, RC, Leiden, The Netherlands

    Lizz van der Heijden MSc, P. D. Sander Dijkstra MD, PhD & Michiel A. J. van de Sande MD, PhD

  2. Department of Oncologic and Reconstructive Orthopaedics, Centro Traumatologico Ortopedico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Domenico A. Campanacci MD, PhD

  3. Oxford Sarcoma Service, Nuffield Orthopaedic Centre, Oxford, UK

    C. L. Max H. Gibbons MD, PhD

Authors
  1. Lizz van der Heijden MSc
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  2. P. D. Sander Dijkstra MD, PhD
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  3. Domenico A. Campanacci MD, PhD
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  4. C. L. Max H. Gibbons MD, PhD
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  5. Michiel A. J. van de Sande MD, PhD
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Corresponding author

Correspondence to Lizz van der Heijden MSc.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Leiden University Medical Center, Leiden, The Netherlands.

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van der Heijden, L., Dijkstra, P.D.S., Campanacci, D.A. et al. Giant Cell Tumor With Pathologic Fracture: Should We Curette or Resect?. Clin Orthop Relat Res 471, 820–829 (2013). https://doi.org/10.1007/s11999-012-2546-6

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  • DOI: https://doi.org/10.1007/s11999-012-2546-6

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