Abstract:Objective To explore the surgical methods after treatment of recurrent bone giant cell tumor with Denosumab.Methods From February 2014 to December 2019,22 patients(9 males,13 females,11 distal femur,11 proximal tibia)with recurrent bone giant cell tumor of the knee were treated with Denosumab in our department.Theaverage age was (34.09±11.62)years (18~55 years).22 patients received 3 months of treatment with Denosumab(subcutaneous injection of 120 mg/times on 1,8,15,29 day and followed by 120 mg/month).22 patients were divided into 2 groups according to surgical methods.12 Patients underwent Intracapsular curettageandbone cement filling and internal fixation in group 1(7 cases of distal femur and 5 cases of proximal tibia).10 Patients underwent wide excision and prosthesis replacement in group 2(4 cases of distal femur and 6 cases of proximal tibia).Postoperative patients were followed up by DR,CT,MRI and local ultrasound.To observe the local recurrence of tumor,the function of the limb was evaluated using the MSTS score of the Musculoskeletal Tumor Society after operation and in three months after operation.Results There was no significant difference in the basic data of 22 patients.22 patients were followed up from 12 months to 48 months with anaverage follow-up of (26.77±9.19)months.The total recurrence rate of the two groups was 13.64% (3/22).There were 3 recurrent cases in group 1(2 cases of distal femur and 1 case of proximal tibia).The recurrence rate in group 1 was 25.00% (3/12).All the postoperative wounds healed in stage I,and there were no surgical complications.There were no recurrent cases in group 2.The recurrence rate in group 2 was 0 (0/10).One patient had vein thrombosis in popliteal vein in one week after operation.But thrombus disappeared after 2 weeks of thrombolysis.1 patient's wound had fat liquefaction.The wound had healed with debridement and suture.There were no related complications such as loosening and dislocation of prosthesis.The MSTS in Group 1 score was (28.17±1.11)and that in Group 2 was (26.70±0.95).The MSTS score in group 1 was significantly higher than that in group 2(P<0.05).Conclusion Denosumab is an effective adjuvant therapy for recurrent bone giant cell tumor,and recurrence risk is higher after discontinuation of medication.Extensive excisionand prosthesis replacement are recommended to reduce the risk of local recurrence after treatment with Denosumab.
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