[The choice strategy of surgical treatment for giant cell tumor close to the knee].
OBJECTIVE
To retrospectively study and analyze the methods of the surgery management for giant cell tumor close to the knee.


METHODS
A retrospective analysis was performed in 121 patients who underwent surgical treatment for giant cell tumor close to the knee between 1978 and 1997. There were 71 cases had been managed with an intralesional procedure of the tumor (curettage, freezing with liquid nitrogen and autograft or allograft, Group 1), 50 cases with a semi-arthroplasty using allograft after en bloc resection (Group 2). According to the relation of the clinical signs and symptoms, tumor character, operative method and local recurrence, limp function, complication were evaluated. Based on the figure of tumor lesion on CT, a new formulation of treatment was given: (1) I diameter of tumor <or= 1/2, choice of an intralesional procedure; (2) II 1/2 approximately 3/4, an intralesional procedure additional inter fixed; (3) III > 3/4, en bloc resection and reconstruction. The prospectively collected records of 65 cases of patients, 45 cases with curettage, heat cauterization with electrocautery and phenol, autograft and cement (Group 1), 20 cases with arthroplasty using prosthetic (Group 2), who had a giant-cell tumor closed knee, were reviewed to determine feasibility of the new formulation of treatment.


RESULTS
The first duration, the rate of the local recurrence between 2 groups showed no statistical difference. There were less complication rate and better limp function after using two different surgical treatment. The second duration, there were no statistical difference with the rate of the local recurrence, complication, and limp function. The number of patients who managed with en bloc resection and reconstruction decreased.


CONCLUSIONS
The choice strategy of surgical treatment for giant cell tumor close to the knee should be based on the figure of tumor lesion on CT. It gives a new formulation of treatment to choice of an intralesional procedure and en bloc resection. An effective intralesional procedure should be the method of the first choice.
Yang
Zheng-ming
ZM
Department of Orthopaedics, the Second Affiliated Hospital, Institute of Orthopaedic Research, Medical College Zhejiang University, Hangzhou 310009, China.
Tao
Hui-min
HM
Yang
Di-sheng
DS
Ye
Zhao-ming
ZM
Li
Wei-xu
WX
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013977:Tibia