Curettage and allograft reconstruction for giant cell tumours.

PURPOSE: To evaluate treatment outcomes in patients with giant cell tumours after curettage and allograft reconstruction and to identify the risk factors for poor oncological and functional outcome. METHODS: 29 patients with giant cell tumours of bone who underwent curettage and allograft reconstruction were retrospectively reviewed. The adjuvants used were heat treatment by electrocautery and hot water. Types of allograft used, time to bone union, complications, functional outcomes, and risk factors for poor function were analysed. RESULTS: The mean time to bone union was 2.8 (range, 1-5) months. In 7 patients the tumours recurred (6 within 2 years); the 5-year recurrence-free survival rate was 77%. Three recurrences were classified as grade III and 4 as grade II; recurrence and the Campanacci grade showed a trend towards association (p=0.06). Tumour in the distal femur was a risk factor for postoperative fracture (p=0.02). Functional outcomes were excellent in 20 patients, good in 6, fair in 2, and a failure in one. The risk factors for poor function were recurrence (p=0.002) and joint instability (p=0.008) but not the Campanacci grade (p=0.10) or postoperative fracture (p=0.76). Lung metastasis, infection, and non-union were not encountered. CONCLUSION: Despite a relatively high recurrence rate (24%), 26 (90%) of the 29 patients had excellent/good functional outcomes. We recommend the use of adjuvants and allografts for the management of giant cell tumours.