Extended curettage and reconstruction with proximal fibula for treating giant cell tumor of lateral femoral condyle: A prospective study

Abstract

Kuriakku Puthur Dominic, Davis Dijoe, Reghunathannair Aravind

Background: The giant cell tumor (GCT) affecting lateral femoral condyle poses problems in reconstruction after the extended curettage of the lesion. This study was aimed to analyze the results of cases in which the upper end of fibula was placed upside down to reconstruct the lateral femoral condyle. Methods: Patients with GCT affecting lateral femoral condyle, who underwent treatment at our institution from January 2008 to June 2013, were selected. Imaging and biopsy were done to confirm the diagnosis as well as to plan the surgery. After extended curettage of the lesion, the void was reconstructed with proximal fibula and allograft. The outcome was measured using Musculoskeletal Tumor Society-87 (MSTS) score and subjected to statistical analysis. Results: In this prospective study, twelve cases (mean age 39) were selected. Among the 12 cases, 7 had sustained the pathological fracture. After a minimum of 2 years of follow-up, the mean MSTS scores in cases with or without pathological fracture were 25.85 ± 2.47 and 27.60 ± 0.54, respectively, which was found statistically non-significant (p = 0.155). The recurrence rate was 16.7%, which underwent repeated curettage, and 8.3% had the infection. Conclusion: Treatment of GCT of lateral femoral condyle by extended curettage and reconstruction with proximal fibula seems to be a viable option with a good functional outcome, even in cases with pathological fractures. The biological form of reconstruction has the long term advantage of remodeling and can incorporate with the reconstruction as permanent.