Early results of the combined grafting–cementation technique for the treatment of giant cell tumors with a large subchondral bone defect: a case series

Background
Giant cell tumor (GCT) is a rare, locally aggressive bone tumor. It typically affects young adults close to the joints, mainly the knee joint. The high recurrence rate, along with erosion of the subchondral bone complicates the surgical plan. Current treatment standards involve extended curettage followed by space-filling by cement or graft. We present a detailed technique using a combined technique using both bone graft and cement for reconstructing GCT-related subchondral damage.
Patients and methods
Eighteen patients underwent surgery from January 2018 to December 2021. The surgery involved extended curettage using a high-speed burr, and lavage using hydrogen peroxide. Placement of the graft as a subchondral shelf helps to support the articular cartilage. Bone cement was applied to fill the cavity and support the graft; internal fixation was used in large-sized lesions.
Results
The mean follow-up is 34.5 months. Oncologically, local recurrence was reported in one case, with a distal radius location, and no distant metastasis was reported. Functionally, 86.6% had excellent/good Musculoskeletal Tumor Society score scores. Graft union had occurred in all cases; mean union time was 12 weeks. Rehabilitation included immediate passive range of motion exercises and partial weight bearing. The pain had improved significantly in all cases. Muscle power had been temporarily affected in five cases. One patient had a wound infection, managed with antibiotics.
Conclusion
Treatment of GCTs is challenging. The standard treatment involves curettage and gap filling. The presence of the cement close to the articular cartilage can lead to osteoarthritis due to different modulus of elasticity. We describe this combined technique to provide support, insulation, and stability, and minimize the stresses on the articular cartilage. The results of this technique are promising and yield good functional and oncological outcomes. Further research is needed to evaluate its long-term efficacy in preventing progressive osteoarthritis.