GCT: What happened after 10 years of curettage and cement? Retrospective study of 46 cases

Abstract

OBJECTIVE: To compare the functional outcome of patients with and without arthrosis, and to determine whether the development of arthrosis is related to the distance of the tumor from the subchondral bone. METHODS: Forty six patients treated for Giant-cell tumor (GCT) between 1975 and 1999 met inclusion criteria. GCT was diagnosed by percutaneous biopsy and confirmed after resection, in all cases. Campanacci's and Kellgren's classification, the distance of the cement to the articular surface and MSTS score were obtained throughout the sample. RESULTS: The distance of the cement to the subchondral bone was associated with greater risk of developing arthrosis, but there was no difference in MSTS scores between patients with or without arthrosis. CONCLUSION: We found that the distance from the cement to the subchondral bone has a prognostic value regarding future arthrosis, but it does not impact on the functional outcome. Level of Evidence IV, Therapeutic Study

Safety, osseointegration, and bone ingrowth analysis of PMMA‐based porous cement on animal metaphyseal bone defect model

“…Baptista et al showed that subchondral lesions, <10 mm from the articular cartilage, are 8 times more likely to progress to arthrosis when treated with solid cement implantation, probably due to cement loosening. 8 This loosening was well documented in this study by bone resorption around the block and a fibrous layer formation. Owing to the lack of mechanical support, subchondral bone and the articular surface may fracture or deform leading to osteoarthritis.…”

“…The subchondral position of the defect created a critical mechanical as well as biological situation. Baptista et al showed that subchondral lesions, <10 mm from the articular cartilage, are 8 times more likely to progress to arthrosis when treated with solid cement implantation, probably due to cement loosening . This loosening was well documented in this study by bone resorption around the block and a fibrous layer formation.…”

“…6,7 Baptista et al by reviewing radiographies of giant cell tumor patients 10 years after implantation of solid cement found that subchondral cement blocks are eight times more likely to develop osteoarthrosis than metaphyseal implantations. 8 Reasonable causes for this kind of failure include interposition of blood clots or debris, confinement of large areas of the subchondral bone and subsequent ischemic necrosis or loosening of the block, and formation of a fibrosis layer around it, thus relaxing the support to the articular cartilage, enabling deformation and subsequent arthrosis. 9 Other possible causes of cement block loosening are overheating during cement setting time and mechanical differences between bone and cement leading to bone resorption.…”

Giant cell tumor locally advanced around the knee: treatment and literature review

“…The use of bone cement is a well-established method that presents good long-term oncological and functional results. Regarding the possibility of arthrosis secondary to the use of bone cement, Baptista et al 4 published a retrospective study of 46 cases of GCT undergoing curettage and cementation, concluding that the distance from cement to subchondral bone has a prognostic relationship to the development of osteoarthritis, but not to final functional outcome of the patient.…”

“…Type III are aggressive, extending throughout the periosteum and surrounding tissues. 3 , 4 , 5

Fig. 1 Campanacci classification.

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