Treatment of giant cell tumor of bone using bone grafting and cementation with versus without gel foam

Abstract

Background: Giant cell tumor (GCT) of bone is a benign locally aggressive tumor that constitutes 20% of the body's benign bone tumors. Most of the GCTs exhibit a typical epiphyseal location that shows a tendency for significant bone destruction and local recurrence. We aimed to assess the functional and oncological outcomes of GCT patients treated with bone grafting and cementation with or without gel foam.
Materials and methods: This prospective study included 40 patients presented at El Hadara University Hospital with GCT of bone around the knee from January 2017 to January 2022 treated by bone graft and cementation. Twenty cases were treated with gel foam (Group I) and 20 cases were treated without gel foam (Group II) through random allocation without selection. Recurrence was assessed as progressive lysis of 5 mm at the bone cement interface. Functional outcomes were assessed using the musculoskeletal tumor society score (MSTS) after a period of minimum 30 months.
Results: In Group I, 18 patients (90%) had excellent results (range 24 and 30) according to MSTS and two patients (10%) had good results (range 18 and 23), while in Group II, 16 patients (80%) had excellent results and four patients (20%) had good results. No patients were graded as having fair or poor results. Twenty patients (100%) had satisfactory results, and no patients (0%) had unsatisfactory results. The overall recurrence rate was about 15%.
Conclusion: Reconstruction of GCT of bone with sandwich technique offers good option as joint preserving surgery. Most of the patients get benefit in terms of better quality of life and good function regardless of age and gender. Subchondral bone grafting reduces the effect of heat on articular cartilage, but longer follow-up is required. There is no benefit of gel foam addition in terms of function or oncological outcome.