title: Iterative curettage is associated with local control in giant cell tumors involving the distal tibia.
abstract: BACKGROUND
  The distal tibia is an unusual location for a giant cell tumor (GCT). Treatment choices are unclear because of their rarity, the anatomy of the ankle, and difficulties associated with reconstruction.
  
  
  OBJECTIVE
  We assessed: (1) the treatment modalities used by participating Canadian bone tumor centers for distal tibia GCTs; (2) the incidence of local recurrence and their management; and (3) patients' function after treatment.
  
  
  METHODS
  A prospective tumor database served to identify all 31 patients with primarily treated distal tibia GCTs between 1991 and 2010. We extracted patients and tumor characteristics, treatment modalities for initial and recurrent tumors, and the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage (TESS) scores. The median followup was 58 months (range, 24-192 months).
  
  
  RESULTS
  Extended curettage was the only modality of treatment for all patients including all subsequent local recurrences. Nine had local recurrence, three of which had a second local recurrence; one had a third recurrence. Ultimately all patients were in remission at last followup. The local recurrence rate was 29% and appeared higher compared with recent series of all anatomic sites. The mean final MSTS and TESS scores were 91% (range, 71%-100%) and 88% (range, 35%-100%), respectively.
  
  
  CONCLUSIONS
  Extended curettage was the unique modality of surgical treatment for all tumors. We found the incidence of local recurrence higher than that reported for other locations but recurrences were manageable with repeated curettage. Complications and function appeared better than those reported for series of ankle fusion or reconstruction for bone tumors.
authors.affiliation: Division of Orthopaedic Surgery, McGill University, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
authors.forename: Saleh A
authors.initials: SA
authors.lastname: AlSulaimani
authors.forename: Robert E
authors.initials: RE
authors.lastname: Turcotte
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002170:Canada; D003475:Curettage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult