Between 1983 and 1993, 102 patients with giant cell tumor of bone were treated at three institutions. Sixteen patients (15.9%) presented with already having had local recurrence. All patients were treated with thorough curettage of the tumor, burr drilling of the tumor inner walls, and cryotherapy by direct pour technique using liquid nitrogen. The average followup was 6.5 years (range, 4-15 years). The rate of local recurrence in the 86 patients treated primarily with cryosurgery was 2.3% (two patients), and the overall recurrence rate was 7.9% (eight patients). Six of these patients were cured by cryosurgery and two underwent resection. Overall, 100 of 102 patients were cured with cryosurgery. Complications associated with cryosurgery included six (5.9%) pathologic fractures, three (2.9%) cases of partial skin necrosis, and two (1.9%) significant degenerative changes. Overall function was good to excellent in 94 patients (92.2%), moderate in seven patients (6.9%), and poor in one patient (0.9%). Cryosurgery has the advantages of joint preservation, excellent functional outcome, and low recurrence rate when compared with other joint preservation procedures. For these reasons, it is recommended as an adjuvant to curettage for most giant cell tumors of bone.

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We have used cryosurgery as an adjunct to curettage to eradicate residual microscopic disease in an effort to improve local tumor control over curettage alone for low-grade extremity chondrosarcoma. Patients with findings on radiographs and CT of fluffy calcification and marrow replacement were candidates for surgery if they exhibited persistent deep pain and endosteal scalloping. All surgeries were performed by similarly trained surgeons at two institutions and consisted of curettage resection through a wide cortical window, followed by high-speed mechanical burring and supplemented by one to two freeze cycles using liquid nitrogen. Defects were reconstructed using a combination of methylmethacrylate and internal fixation with Rush rods or Enders pins. A total of 46 tumors in the proximal humerus (23), distal femur (16), proximal tibia (4), and hand/wrist (3) are presented. Average length of followup was 73 months (range: 25 to 161 months). There were no local recurrences or distant metastases. Functional results in the proximal humerus were as follows: 14/23 good (i.e. minimal pain and/or minimal limitation of motion), 6/23 excellent (no pain, normal range of motion) and 3/23 fair. In the distal femur, outcomes were 2/16 excellent, 13/16 good and 1/16 fair. One nondisplaced unicortical fracture in the distal femur was treated successfully without immobilization. One 70 year-old patient with late (3-year) postoperative degenerative changes of the shoulder underwent shoulder arthroplasty. Curettage-resection and cryosurgery for low-grade chondrosarcoma allows for excellent preservation of function with minimal rates of complications and recurrence. We do not recommend en-bloc resection for the treatment of low-grade extremity chondrosarcoma.