Objective To investigate the relationship between initial operation and recurrence of primary giant cell tumor of bone (GCT). Method From January 2014 to April 2018,44 cases of primary giant cell tumor of bone were treated by initial operation.operative approach include scraping and grafting of intra-capsule lesions or bone cement filling, margin resection, and extensive resection. Result 44 patients were followed up from 12 months to 56 months.There were 5 cases of recurrence and 1 case of lung metastasis. The total recurrence rate was 11.4% and the lung metastasis rate was 2.3%.18 cases were treated with intracapsular curettage and bone graft. 2 cases recurred.the recurrence rate was 11.1%. 22 cases were treated with intravesical scraping and filling with bone cement. 3 cases recurred. the recurrence rate was 13.6%.There was no significant difference in recurrence rate between bone graft group and cement group.There were no recurrence of 2 cases of margin resection and 2 cases of extensive resection.1 case recurred in 8 cases with pathological fracture, the recurrence rate was 12.5%.Recurrence rate of non-pathological fracture group was 11.1%.There was no statistical significance in recurrence rate between the two groups. Conclusion Most cases of giant cell tumor of bone (Campanacci Ⅰ, Ⅱ and III grade) can be removed by intracapsular curettage，extensive curettage and auxiliary treatment of tumor bed can get good local control.