Joint Salvage for Pathologic Fracture of Giant Cell Tumor of the Lower Extremity

Abstract

Pathologic fracture through giant cell tumor is thought to be associated with higher rates of recurrence and poor functional outcome. We compared patients with and without pathologic fracture through giant cell tumor of weightbearing long bones. We retrospectively reviewed 139 patients with giant cell tumor of weightbearing long bones with (n = 43) and without (n = 96) pathologic fracture at presentation; the two groups had similar demographics. Joint salvage was successful in 84% of the fracture group and 96% of the nonfracture group. Five-year recurrence-free survival rates were comparable between the two groups (82.6% [95% confidence interval, 69.1-95.9%] in the fracture group and 77.9% [95% confidence interval, 67.7-88.1%] in the non-fracture group). There was a trend toward lower 5-year metastatic-free survival in the fracture group (94.7% [95% confidence interval, 87.3-100%]) than in the nonfracture group (97.3% [95% confidence interval, 93.5-100%]). Functional outcome was good and similar in the two groups. Arthrofibrosis was more common in the group with pathologic fracture. Joint salvage for patients with pathologic fractures through giant cell tumor of weightbearing bones is a reasonable option with functional outcomes and recurrence rates comparable to those of patients without fracture.

Giant cell tumour of bone: a new evaluating system is necessary

“…However, to our knowledge, there is no clear definition of "more," "extensive" or "severe" destruction" in grade III GCTs and the reported indications of wide resection for GCT are also heterogeneous [5,7,22,23,30,38]. Furthermore, another dilemma of the application of the system of Campanacci et al is that some authors declared that conservative treatments instead of wide resection should be recommended for grade III GCTs [44,45]. Therefore, the role of the classifications of Enneking and Campanacci et al in planning the initial surgical treatment is limited.…”

“…There are limited data in the literature comparing local recurrence rates between patients with and without pathological fracture [4,7,8]. Deheshi et al [45] found no difference in local recurrence after curettage between patients with or without pathological fracture. However, in a Canadian multicentre study by Turcotte et al involving 186 patients, displaced fracture was shown to be a prognostic factor for local recurrence [28].…”

“…But is this an accurate interpretation? Deheshi et al [45] attempted to perform joint salvage in lesions of the distal femur or proximal tibia. They found joint salvage was performed in more patients without pathological fracture than patients with pathological fracture (96 % vs 84 %, P00.035).…”

“…There is an approximately 20-30 % incidence of pathological fracture at presentation [4,45]. Pathological fractures have been considered to signify a potentially more aggressive subset of GCT, less amenable to joint salvage, with higher local and systemic recurrence rates and inferior functional outcomes compared to patients without pathological fracture [51,52].…”

Giant cell tumor of bone: current review of morphological, clinical, radiological, and therapeutic characteristics

“…Deheshi et al [91] indicate that there is no difference in terms of recurrence after curettage in patients with or without a pathological fracture. Dreinhöfer et al [92] also believe that pathological fracture is not a contraindication for curettage and PMMA.…”