Original Article

Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee

¹ Professor, Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, Uttar Pradesh, India
² Department of Orthopaedics, All India Institute of Medical Sciences, 110029 New Delhi, India
³ Senior Resident, Department of Trauma and Emergency (Orthopaedics), All India Institute of Medical Sciences, Raipur 492099, Chhattisgarh, India
⁴ Senior Resident, Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, Uttar Pradesh, India
⁵ Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, 249203 Rishikesh, Uttarakhand, India

^* Corresponding author: iyerdinesh212@gmail.com

Received: 7 May 2021
Accepted: 31 August 2021

Abstract

Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 patients had full extension and knee flexion more than 100 degrees. The mean MSTS score was 25.2. Three patients had an MSTS score under 20. All three patients had an extension lag with a restricted range of motion. Conclusion: Joint preservation surgery, when done in line with the basic principles of tumor surgery, gives good radiographic and functional outcomes even in grade 2 and 3 giant cell tumors of bone around the knee and should be attempted before replacement surgeries.