Treatment of giant-cell tumors of long bones with curettage and bone-grafting

Background: The use of curettage, phenol, and cement is accepted by most ex perts as the best treatment for giant-cell tumor of bone. The present study was performed to evaluate whether equivalent results could be obtained wit h curettage with use of a high-speed burr and reconstruction of the resulti ng defect with autogenous bone graft with or without allograft bone. Methods: The prospectively collected records of patients who had a giant-ce ll tumor of a long bone were reviewed to determine the rate of local recurr ence after treatment with curettage with use of a high-speed burr and recon struction with autogenous bone graft with or without allograft bone. All of the patients were followed clinically and radiographically, and a biopsy w as performed if there were any suspicious changes, Results: Fifty-nine patients met the criteria for inclusion in the study. A ccording to the grading system of Campanacci et al,, two patients (3 percen t) had a grade-I tumor, twenty-nine (49 percent) had a grade-II tumor, and twenty-eight (47 percent) had a grade-III tumor. Seventeen patients (29 per cent) had a pathological fracture at the time of presentation. The mean dur ation of follow-up was eighty months (range, twenty-eight to 132 months). S even patients (12 percent) had a local recurrence. Six of these seven were disease-free at the latest follow-up examination after at least one additio nal treatment,vith curettage or soft-tissue resection (one patient). One pa tient had resection and reconstruction with a prosthesis after a massive lo cal recurrence and pulmonary metastases. Conclusions: Despite the high rates of recurrence reported in the literatur e after treatment of giant-cell tumor with curettage and bone-grafting, the results of the present study suggest that the risk of local recurrence aft er curettage with a high-speed burr and reconstruction with autogenous graf t with or without allograft bone is similar to that observed after use of c ement and other adjuvant treatment. It is likely that the adequacy of the r emoval of the tumor rather than the use of adjuvant modalities is what dete rmines the risk of recurrence.