Campanacci stage and cortical destruction predict functional outcomes in giant cell tumor of bone

BACKGROUND: Although intralesional curettage remains the standard treatment for giant cell tumor of bone (GCTB), the radiological determinants of postoperative functional outcomes remain incompletely defined. This study aimed to evaluate the association between clinicodemographic and radiologic characteristics and functional outcomes, local recurrence, and complications following surgical treatment of GCTB. METHODS: A retrospective analysis was performed on 27 patients treated surgically for GCTB. Demographic variables, Campanacci stage, tumor burden metrics, and MRI features were recorded. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score. Univariate comparisons were conducted for recurrence and complications. Multivariate linear regression analyses were performed to identify independent predictors of postoperative MSTS scores. RESULTS: Local recurrence occurred in 3 patients (11.1%). On univariate analysis, Campanacci stage III, soft tissue extension, higher tumor volume, increased tumor-to-bone ratio, and the presence of the paintbrush border sign were significantly associated with recurrence. Postoperative complications were observed in 6 patients (22.2%) and were associated with older age and greater tumor volume. In multivariate linear regression analyses of postoperative functional outcomes, Campanacci stage III and cortical destruction independently predicted lower MSTS scores when evaluated in separate, collinearity-adjusted models (β = - 2.8, p = 0.007 and β = - 2.4, p = 0.010, respectively). CONCLUSIONS: Functional outcomes following surgical treatment of GCTB are primarily determined by tumor stage and structural integrity rather than demographic factors. Advanced disease and loss of cortical continuity are associated with inferior postoperative function, highlighting the importance of radiologic assessment in surgical planning and patient counseling.