Burden of complications after giant-cell tumor surgery. A single-center retrospective study of 192 cases.

BACKGROUND: Surgical complications are frequent with giant-cell tumor of bone; recurrence is the best known and most widely studies; other causes of failure have been less well investigated. We therefore performed a retrospective study to identify and assess the main reasons for surgical revision.

HYPOTHESIS: Recurrence is the main cause of surgical revision in giant-cell tumor of bone, but other complications, such as mechanical issues or infection, are underestimated.

PATIENTS AND METHODS: A single-center retrospective study included 192 patients (included from 2000 to 2016) undergoing first giant-cell tumor of bone surgery in a bone tumor reference center. Surgery consisted in curettage for 152 patients (79%) and resection for 40 (21%). The 3 main reconstruction techniques were filling (136 patients; 71%), prosthesis (18 patients; 9%), and fusion (14 patients: 7%). Filling used cement in 9 cases (7%) and bone graft in 127 (93%). Cumulative incidence functions were calculated.

RESULTS: There were 171 revision procedures in 92 patients:  43 for mechanical reasons, 30 for infection, 86 for tumor recurrence, 12 for other causes. Cumulative incidence of revision at 10 years was 36% (95% CI: 27-44) for recurrence, 26% (95% CI: 17-36) for mechanical causes, and 13% (95% CI: 9-19) for infection, for overall cumulative incidence of revision of 61% (95% CI: 50-69).

DISCUSSION: Risk of all-cause surgical revision in giant-cell tumor of bone was 61% at 10 years, with recurrence accounting for only half of cases.

LEVEL OF EVIDENCE: IV.