Y C Fong1, T H Chen, W M Chen, W H Lo. 1. Department of Orthopedics, China Medical College Hospital, Taichung, Taiwan, R.O.C.
Abstract
BACKGROUND: In most of the reported series, almost half of the giant-cell tumors involved the knee region. The characteristics of the lesions were usually benign but often locally aggressive and easily recurrent neoplasms. Some surgeons performed intralesional excision combined with local adjunctive chemical coagulant, and bone grafting or methylmethacrylate cement packing. These methods could both decrease local recurrence and retain the function of joint. METHODS: From January, 1984 to December, 1994, a review was made of the results for eighteen patients who had been managed consecutively at the Veterans General Hospital-Taipei for giant-cell tumor of bone around the knee. Fourteen instances had occurred in the proximal tibia and four, in the distal femur. According to the classification of Campanacci, nine lesions were Stage II and nine, Stage III. Eleven patients had been managed with intralesional excision of the tumor with local adjunctive application; the other seven had en bloc resection and reconstructive procedures. RESULTS: All patients had been followed for a mean of fifty-six months (range 22 to 125 months). The overall recurrence rate was 11% (2/18). The intralesional excision had 18% (2/11) recurrence; there was no recurrence in the en bloc resection (0/7). The complication rate was 16% (4/18); 9% (1/11) for intralesional excision and 42% (3/7) for en bloc resection, respectively. The mean functional score was 28 points (range, 22 to 30) in the intralesional excision group and 21 points (range, 11 to 30) in the en bloc resection group. CONCLUSIONS: En bloc resection with reconstruction had a lower rate of recurrence, but a higher rate of complication and poor functional results. Intralesional excision, combined with a local adjunctive application and packed with bone grafting or methylmethacrylate cement, was an acceptably good method with satisfactory results, which either decreased local recurrence or retained the function of the joint.
BACKGROUND: In most of the reported series, almost half of the giant-cell tumors involved the knee region. The characteristics of the lesions were usually benign but often locally aggressive and easily recurrent neoplasms. Some surgeons performed intralesional excision combined with local adjunctive chemical coagulant, and bone grafting or methylmethacrylate cement packing. These methods could both decrease local recurrence and retain the function of joint. METHODS: From January, 1984 to December, 1994, a review was made of the results for eighteen patients who had been managed consecutively at the Veterans General Hospital-Taipei for giant-cell tumor of bone around the knee. Fourteen instances had occurred in the proximal tibia and four, in the distal femur. According to the classification of Campanacci, nine lesions were Stage II and nine, Stage III. Eleven patients had been managed with intralesional excision of the tumor with local adjunctive application; the other seven had en bloc resection and reconstructive procedures. RESULTS: All patients had been followed for a mean of fifty-six months (range 22 to 125 months). The overall recurrence rate was 11% (2/18). The intralesional excision had 18% (2/11) recurrence; there was no recurrence in the en bloc resection (0/7). The complication rate was 16% (4/18); 9% (1/11) for intralesional excision and 42% (3/7) for en bloc resection, respectively. The mean functional score was 28 points (range, 22 to 30) in the intralesional excision group and 21 points (range, 11 to 30) in the en bloc resection group. CONCLUSIONS: En bloc resection with reconstruction had a lower rate of recurrence, but a higher rate of complication and poor functional results. Intralesional excision, combined with a local adjunctive application and packed with bone grafting or methylmethacrylate cement, was an acceptably good method with satisfactory results, which either decreased local recurrence or retained the function of the joint.