it is a benign locally aggressive tumor usually involving the distal end of the femur , proximal tibia and distal radius in young adults .
the main variables to be considered for planning treatment include the site of involvement and campanacci stage of the tumor .
different treatment options are available which include intralesional curettage , extended curettage , wide resection and reconstruction
. functional and oncological outcome of these treatment options varies widely , the predominant detrimental factor being tumor recurrence rate .
reconstruction of endoprosthesis after wide excision of the tumor offers good short - term and mid - term functional and oncological outcomes as established by previous studies .
this study was conducted to evaluate the long - term outcome of 11 patients with gct who underwent wide excision and customized endoprosthetic replacement .
this study included 11 patients ( eight men and three women ) aged 2448 ( mean 32 ) years with primary gct of proximal femur campanacci stage - iii who were available for mean follow - up duration of 10.6 ( range 10.214 ) years .
the definite diagnosis was established on histopathological confirmation with incisional biopsy . computed tomography scan of chest and bone scan
none of the patients had pulmonary metastasis , and all the 11 patients had a solitary lesion in the proximal femur .
these patients underwent wide resection of the tumor using postero - lateral approach to the proximal femur .
the proximal femur was reconstructed using a customized , titanium , cemented endoprosthesis [ figure 1 ] .
hip abductors , short external rotators and iliopsoas tendon were secured onto the prosthesis and hip capsule repair was performed .
postoperative rehabilitation protocol included nonweight bearing and abduction splinting of the limb for 6 weeks followed by nonweight bearing crutch walking for another 6 weeks . once the hip abductors and quadriceps strength was regained weight bearing was allowed .
long - term functional outcome was evaluated at minimum 10 years duration using revised musculoskeletal tumor society rating scale .
( a ) radiogragh showing giant cell tumor of proximal femur in a 34-year - old man .
( b ) magnetic resonance imaging showing giant cell tumor of proximal femur with soft tissue extension .
there were no instances of prosthesis related complications like aseptic loosening or dislocation . at the end of mean 10.6 years
six patients had good hip function without any restrictions , four patients had intermediate functional restriction whereas one had the recreational restriction of function .
nine patients enthusiastically accepted the outcome of the procedure whereas two patients had satisfactory emotional acceptance .
eight patients were walking without any support with unlimited walking abilities whereas three patients were using a cane for support while walking .
the mean is revised musculoskeletal tumor society score was 26.8 out of 30 [ table 1 ] .
traditional treatment of gct has been a difficult problem in orthopaedic oncology owing to high recurrence rates following conventional treatment with curettage or extended curettage . ideally treatment
currently with improvement in reconstructive surgical techniques and availability of high quality biomechanically designed megaprosthesis , wide resection of tumor with proximal femur endoprosthesis replacement is being considered as a treatment option for campanacci stage - iii lesions in proximal femur with extensive osteolysis and soft tissue extension .
it offers good local control of s with least recurrence rate and favorable functional outcome .
the previous studies have shown satisfactory short- and mid - term functional and oncological outcomes .
this study shows good long - term functional , and oncological outcomes of the procedure and hence the authors recommended as an endoprosthetic replacement for advanced gct of the proximal femur .
furthermore , randomized control trials are required to established this modality as a standard treatment .
 introduction : giant cell tumor ( gct ) of bone is locally aggressive benign tumor involving the epiphysis of long bones in young adults . various treatment options include intralesional curettage , extended curettage , wide resection , resection and reconstruction and amputation . 
 the main variables to be considered for planning treatment include the site of involvement and campanacci stage of the tumor . 
 functional and oncological outcomes of these treatment options vary widely , the predominant detrimental factor being tumor recurrence rate.aim:a study was conducted to evaluate the long - term oncological and functional outcome of patients with gct of the proximal femur that underwent tumor resection and endoprosthetic replacement.materials and methods : eleven patients with campanacci stage - iii gct of proximal femur who underwent wide excision of tumor and endoprosthesis replacement with a mean follow - up the duration of 10.6 years were assessed using standard proforma . 
 the treatment outcome was evaluated using the revised musculoskeletal tumor society rating scale for the lower extremity.results:at mean follow - up the duration of 10.6 years , none of the cases had tumor recurrence , infection , prosthesis loosening or dislocation . 
 all the patients were community ambulators among whom eight patients were walking without support while three patients were using a cane for support . 
 the mean total musculoskeletal tumor society score was 26.8 out of 30 indicating the good outcome.conclusions:the authors recommend that wide resection and endoprosthetic replacement should be considered as a preferred treatment option for proximal femur gct as the functional , and oncological outcome is satisfactory with this modality of treatment . 
I
M
R
D
Financial support and sponsorship
Conflicts of interest