Bone combined cement grafting in giant cell tumor around the knee reduces mechanical failure

Teng, Wangsiyuan; Lin, Peng; Li, Yong; Yan, Xiaobo; Li, Hengyuan; Li, Binghao; Wang, Zhan; Wu, Yan; Wang, Shengdong; Zhou, Xingzhi; Wang, Zenan; Ye, Zhaoming

doi:10.1007/s00264-018-3939-2

Cited by 27 publications

(27 citation statements)

References 21 publications

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“…In contrast, in the present study, the complications rate was comparable between curettage and resection (15.2% versus 15.4%). As recently reported by Teng et al combined bone grafting and cementation reduced the risk of mechanical failure in the knee due to the thin subchondral bone; this technique may be also performed in patients with GCTB of the knee with a pathological fracture.…”

Section: Discussionmentioning

confidence: 80%

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Tsukamoto

Mavrogenis

Tanzi

et al. 2019

Journal of Surgical Oncology

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Background There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients. Materials and Methods We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow‐up was 79.5 months (57.0‐125.5 months). We evaluated local recurrence and type of surgery‐related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score. Results Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage. Conclusion Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.

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Section: Discussionmentioning

confidence: 80%

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Tsukamoto

Mavrogenis

Tanzi

et al. 2019

Journal of Surgical Oncology

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“…The newer brand of bone filler is the bone substitute category which contains a larger range of synthetic substances from calcium phosphate or sulfate mixtures to bioengineered matrixes [7, 8]. A relatively novel technique in which PMMA is added to autograft or allograft has also seen promising results at providing mechanical stability in more recent years [9, 10]. Short-term complications after bone filling can lead to a difficult course of recovery requiring surgical revision; these include recurrence, fracture, or deep infection.…”

Section: Introductionmentioning

confidence: 99%

Early postoperative compilations of bone filling in curettage defects

Chen¹,

Brien²

2019

J Orthop Surg Res

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Background Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for mechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl methacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of the study is to show that good functional result can be achieved with curettage and bone filler, regardless of type. Methods A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment and placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and paresthesia. Complication rates at our single institution were compared against literature values for three study cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Z -score for two populations were used to compare our subset against literature values and between different bone filling types. Results Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which the bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate of 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any complications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had sample sizes too small for statistical comparison. Statistical comparison yielded no significant difference between complications in any of the filling groups ( P = 0.411). Conclusions Some has even argued that bone defects following curettage do not require bone filling for good outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be conferred by filling large bone defects. There was no significant difference in postoperative complication rates between allograft, bone graft substitute, and PMMA when compared at our institution and with literature values. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent reconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as a suitable alternative to other bone filling modalities.

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“…Successful results have been also shown with the use of DBM in combination with steroids. [17] Teng et al [18] reported that the combined use of allograft and cement in giant-cell bone tumors around the knee has led to less mechanical failure and they suggest this method as an optimal reconstruction strategy. In the literature review, we could not find any data about the combined use of DBM and cement as well as the effect of new bone formation in cortical window on functional scores.…”

Section: Discussionmentioning

confidence: 99%

Use of cement combined grafting in upper and lower extremity benign bone tumors

et al. 2020

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There is no standard procedure for the treatment of benign bone tumors. The bone defect following the curettage of the bone tumor can be filled with autologous bone marrow, polymethylmethacrylate cement, allograft, tricalcium phosphate, and demineralized bone matrix (DBM). All these procedures have their own advantages and disadvantages. Autografting is the gold standard in tumor surgery; nevertheless, its disadvantages including limited access, cosmetic problems, and donor site morbidity make the alternative treatment modalities as viable options. Resorption of graft material and transmission of disease are associated risks of allograft use. [1] Polymethylmethacrylate cement is non-biological and its Young's modulus of elasticity is lower than cortical bone, responds to compression-distraction forces differently compared with cortical bone, and has poor tensile and shear strength. [2] Demineralized bone matrix is expensive and osteoinductive without structural support. [3] Our hypothesis was that cement combined DBM treatment stimulates new bone formation, thus improves the functional scores. To the authors' knowledge, no study has focused on this technique Objectives: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. Patients and methods: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. Results: Median tumor volume was 17.2 cm 3 (range, 2.8 to 139.6 cm 3), median area of the cortical window was 8.3 cm 2 (range, 1.6 to 28.4 cm 2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r=-0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r=-0.577). Conclusion: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.

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Bone combined cement grafting in giant cell tumor around the knee reduces mechanical failure

Cited by 27 publications

References 21 publications

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Early postoperative compilations of bone filling in curettage defects

Use of cement combined grafting in upper and lower extremity benign bone tumors

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