Functional and Radiological Outcomes of Surgical Treatment of Giant Cell Tumor of Bone Using Liquid Nitrogen as Adjuvant Therapy

Abstract

Background and Objective: Giant Cell Tumor (GCT) is a relatively uncommon aggressive primary bone
tumor. With simple curettage, the recurrence rate is high. Several adjuvants like Liquid Nitrogen, Hydrogen
Peroxide, Ethanol, Polymethylmethacrylate (PMMA) and Phenol, have been used to reduce the recurrence
rate of this potentially aggressive benign tumors. Liquid nitrogen is used as an adjuvant that causes controlled
necrosis and intracellular destruction of tumor stromal cells. Thus, this study was conducted to determine the
role of liquid nitrogen as an adjuvant therapy for the surgical treatment of GCT in term of functional
outcomes, complications and reduction of recurrence with this treatment modality.
Methods: After ethical permission from institutional review board, this quasi experimental study was
conducted at the Department of Orthopaedic Surgery, Services Hospital Lahore from January 2023 to
December 2023. The study included 22 patients with established diagnosis of Giant Cell Tumor of bone in
different bones. All these patients underwent adjuvant therapy with Liquid nitrogen after Extended
Curettage. The Sub chondral bone was packed with iliac crest bone graft while the cavity was filled with Bone
Cement and it was fixed with some sort of fixation device like Butress plate for Proximal Tibia, distal Femur
Locking Plate for distal Femur etc., At follow up of 12 months, the recurrence rate of tumor, functional
outcomes of joint in terms of MSTS scores and complications like infection, skin breakdown, implant
loosening and neurological deficit were noted.
Results: Out of 22 patients, 13 (59%) were female and 9 (41%) male, with a mean age of 36 ± 11 years. The
overall mean MSTS score was 88.98 ± 7.0, with higher scores for lower limb cases (92.26 ± 6.9) compared to
upper limb cases (85.99 ± 7.1). Complications included recurrence in 3 (13.63%), skin breakdown in 1
(4.5%), and superficial infection in 3 (13.63%).
Conclusion: Extended curettage using Liquid Nitrogen as adjuvant therapy is associated with low recurrence
rate and an effective treatment for these tumors. It also has good functional outcomes with low complications
rate.