CORR Insights^®: Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

Excerpt

Existing outcomes studies on the treatment of giant cell tumor (GCT) of bone are largely retrospective, single institution case series [2‐6]. Numerous treatment options have been described, surgeon preferences vary, and studies provide conflicting results. Unfortunately, the heterogeneity in presentation of GCT of bone and number of tumor variables that can affect outcomes makes it difficult to compare the results of different treatment strategies. Important tumor and patient variables include age, anatomic location (both the bone involved and the proximity to the chondral surface), lesion size, amount of subchondral involvement, presence of pathologic fracture, degree of preexisting degenerative arthritis, BMI, and tumor biology. To compare treatment options, one must first try to account for these important variables. Key questions about therapy include whether to perform curettage versus resection, which adjuvant to use following curettage, whether to use bone graft versus polymethylmethacrylate (PMMA) following curettage, the appropriate bone graft selection, and whether to add bone graft to the subchondral surface when using PMMA. Endpoints of interest include local recurrence, fracture, need for revision surgery, secondary osteoarthritis, and function. More recent treatment options including embolization, denosumab, and bisphosphonates further complicate the decision-making process. …