Abstract
Introduction
The role of adjuvants in curettage for giant cell tumours (GCT) is still controversial. Our aim was to determine if adjuvant cementation lowers local recurrence (LR) rates for GCTs treated with curettage.
Methods
Detailed curettage has been the principal treatment for GCT for the past 30 years. Cement was used from 1996 onwards for tumours where there was concern about structural stability. We investigated factors affecting LR and also the incidence of complications for treatment with or without cement.
Results
From 1975 to 2008, 330 patients with GCT were treated primarily with curettage. Eighty-four (25%) received adjuvant treatment with acrylic bone cementation. Cement was only used in Campannacci grade 2 or 3 GCTs. LR for curettage was 30% compared with 14% for curettage plus cementation. (p = 0.001). LR was halved by the use of cement for both stage 2 and stage 3 tumours (Stage 2, 8% LR with cement, 21% without (p=0.02); Stage 3, 19% with cement, 48% without (p⋋0.001)). On multivariate analysis both stage and use of cement were independent significant factors in predicting LR. Site was not significant although the distal tibia and proximal humerus had lower risk of LR than other sites. Cement was however associated with a higher risk for subsequent joint replacement surgery. In patients without LR, 18% with cement needed a joint replacement compared to 2% without. In patients with LR, 75% with cement required a joint replacement, compared to 44% without.
Discussion
Although adjuvant cementation seems to give better local control for curettage of GCT, it is associated with an increased need for subsequent joint replacement.
