Giant cell tumor of bone.

Giant cell tumor of bone is an unusual neoplasm and treatment commonly leads to local recurrence. This can be related to the aggressiveness of the tumor or to the incompleteness of its removal. This study includes 27 cases that presented to our institution between the 1984 and 1994. One case was as a consultation only and 9 cases, either Campanacci Grade 3 or patients with considerable joint destruction, were treated by resection and reconstruction. One case was treated by curettage and cementation. Sixteen cases were treated with a combination of radical curettage, high speed burring, pulsatile lavage, and bone graft (either autograft or allograft mixed with autograft). No other adjuvant therapy was used. All of these 16 cases had a minimum follow-up of 5 years and none had a local recurrence. This study demonstrates that local control of giant cell tumors can be obtained by appropriate staging, resection of aggressive tumors, and by conservative management of the others. Such conservative management provides a bony matrix for the subchondral bone that is preferable to other treatments that have become popular in recent years, including cementation. This should provide better joint function in the longer term. High local recurrence rates have been reported in other series, but by a combination of appropriate selection of cases and by careful treatment of the Campanacci Grade 1 and 2 cases, these patients can have an uncomplicated outcome.