Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Daniela Kristina D. Carolino (Institute of Orthopaedics and Sports Medicine St. Luke’s Medical Center, Philippines)
Edwin Joseph R. Guerzon (Institute of Orthopaedics and Sports Medicine St. Luke’s Medical Center, Philippines)
Richard S. Rotor (Institute of Orthopaedics and Sports Medicine St. Luke’s Medical Center, Philippines)

Article ID: 3669



Giant cell tumor of the bone (GCTB) is a benign, locally aggressive neoplasm that is relatively rare, with a propensity to result in progressive bone destruction, and is associated with a high risk of recurrence. There is no widely held consensus regarding its ideal treatment. Worldwide, there are varying techniques ranging from intralesional curettage to resection of the lesion, supplemented with combinations of numerous adjuncts and fillers, depending on the resected amount and integrity of bone, as well as the preference of the surgeon. This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals. The mean follow-up period was 37.3 months (SD=2.84). The extended curettage (EC) group had a mean Musculoskeletal Tumor Rating Scale (MSTS) score of 28.18 (SD=7.51) which is considered as an excellent outcome, while the resection (RS) group had an mean MSTS score of 19.67 (SD=11.02), which is considered as a good outcome. EC resulted to a total of eight complications (47%), while RS had one complication (33%). Prevalence of recurrence was noted to be 11.75% among those who underwent EC, while no recurrence was noted among those in the RS group. Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts, however were both were noted to result in excellent functional outcomes. Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC, there is still report of excellent functionality. It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.


Giant cell tumor; Functional outcomes; Complications; Recurrence

Full Text:



[1] Domanski HA, Walther CS. FNA cytology of soft tissue and bone tumors. Monogr Clin Cytol. Basel, Karger, 2017, vol 22, pp 165-170. doi: 10.1159/000475109.

[2] Amanatullah DF, Clerk TR, Lopez MJ, et al. GIant cell tumor of bone. Orthopedics. 2014 Feb;37(2):112-20. doi: 10.3928/01477447-20140124-08.

[3] Sobti A, Agrawal P, Agarwala S, et al. Giant cell tumor of bone - an overview. Arch Bone Jt Surg. 2016 Jan; 4(1):2-9.

[4] Wang, EHM. Bone transplantation in limb saving surgeries: the Philippine experience. Trans Nat Aca Sci Tech Phils. 1998 Jul, vol 20, pp 370-375.

[5] Mavrogenis AF, Igoumenou VG, Soucacos PN. Giant cell tumor of bone revisited. SICOT J. 2017;3:54.

[6] Chakarun CJ, Forrester DM, Gottsegen CJ, et al. Giant cell tumor of bone: review, mimics, and new developments in treatment. RadioGraphics 2013;33:197-211.

[7] Enneking WF, Dunham W, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241-246.

[8] Mohler DG, Chiu R, et al. Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res (2010) 468:2765-2773.

[9] He H, Zeng H, et al. Surgical treatment options for giant cell tumors of bone around the knee joint: extended curettage or segmental resection? Front. Oncol. (2019) 9:946. doi: 10.3389/fonc.2019.00946.

[10] Bus MP, van de Sande MA, et al. What are the long-term results of MUTARS R modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal tibia? Clin Orthop Relat Res. (2017) 475:708–18. doi: 10.1007/s11999-015-4644-8.

[11] Houdek MT, Wagner ER, et al. Long term outcomes of cemented endoprosthetic reconstruction for periarticular tumors of the distal femur. Knee. (2016) 23:167– 72. doi: 10.1016/j.knee.2015.08.010.

[12] Bertoni F, Bacchini P, Staals EL, et al. Malignancy in giant cell tumor of bone. Cancer. (2003)15;97(10):2520-9. doi: 10.1002/cncr.11359.

[13] Kapoor SK, Thiyam R, et al. Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma. (2015) Dec; 6(4):244-251. doi:10.1016/j.jcot.2015.04.005.

[14] Puri A, Agarwal M. Treatment of giant cell tumor og bone: current concepts. Indian J Orthop. (2007) Apr-Jun; 41(2):101-108. doi:10.4103/0019-5413.32039.

[15] Omlor GW, Lange J, Streit M, et al. Retrospective analysis of 51 intralesionally treated cases with progressed giant cell tumor of bone: local adjuvant use of hydrogen peroxide reduces the risk of tumor recurrence. World J Surg Onc 17,73 (2019).

[16] Klenke FM, Wnger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors and recurrence. Clin Orthop Relat Res. (2011) Feb;469(2):591-599. doi:10.1007/s11999-010-1501-7.

[17] Teixeira LEM, Miranda RH, Druda OD, et al. Isolated cauterization as an adjunct in the treatment of benign bone tumors. Acta Ortop Bras. (2011);19(4):198-201.

[18] Jamshidi K, Zandrahimi F, Bozorgi MH, et al. Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumor of the knee with pathologic fracture: a retrospective study. International Orthopedics (SICOT) (2020).

[19] Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol (2008) 134:969-978. doi: 10.1007/s00432-008-0370-x.

[20] Li D, Zhang J, Xia J, et al. Surgery methods and soft tissue extension are the potential risk factors of local recurrence in giant cell tumor of bone. World Journal of Surgical Oncology (2016) 14:114. doi:10.1186/s12957-016-0871-z.

[21] Jones KB, DeYoung BR, Morcuende JA, Buckwalter JA. Ethanol as a local adjuvant for giant cell tumor of bone. Iowa Orthop J. (2006) 26:69-76.

[22] Vaishya R, Pokhrel A, Agarwal AK, Vijay V. Current status of bone cementing and bone grafting for giant cell tumor of bone: a systemic review. Ann R Coll Surg Engl (2019) Feb;101(2):79-85. doi:10.1308/rcsann.2019.0004.

[23] Gao Z, Yin J, Xie X, et al. Local control of giant cell tumors of the long bone after aggressive curettage with and without bone cement. BMC Musculoskelet Disord (2014); 15:330. doi: 10.1186/1471-2474-15-330.


  • There are currently no refbacks.
Copyright © 2021 Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.