Treatment of giant cell tumors with allograft transplants: a 30-year study

We retrospectively reviewed 144 patients with giant cell tumors who had resection and implantation of cadaveric allografts from 1971-2001. Most procedures were done in the distal femur, proximal tibia, proximal femur, and proximal humerus. Seventy-eight percent of patients have retained their grafts and remain functional, but with limitations. Tumor complications included local recurrences (eight patients, none required an amputation) and metastases (three patients). None of the patients died. Allograft fracture occurred in 30 (21%) of the 144 patients, nonunion occurred in 12 (8%) patients, and infection occurred in 12 (8%) patients. Only patients with infection had a marked decline in outcome. Four patients required amputations, and only two of the eight patients with infection (17%) retained a functional graft. Eighty of the 144 patients (56%) had no complications, with a 94% success rate for the procedure. There have been fewer grafts done with the advent of burring, phenolization, and insertion of polymethylmethacrylate. However, based on our data and the good outcome for more extensive and destructive tumors, allograft implants can be used for treatment of patients with aggressive tumors, tumors that have caused fractures, or tumors that have recurred after conservative treatment.