Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone

Suzuki, Yoshitaka; Nishida, Yoshihiro; Yamada, Yoshihisa; Tsukushi, Satoshi; Sugiura, Hideshi; Nakashima, Hiroatsu; Ishiguro, Naoki

doi:10.1016/j.knee.2007.05.008

Cited by 41 publications

(50 citation statements)

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“…These results are consistent with those reported by Murphey et al (14), whereby 84-99% of lesions extended to locations within 1 cm of subarticular bone (14). Suzuki et al (20) reported that less residual thickness of subarticular bone correlated with higher recurrence following surgery for GCTB, and tended to be associated with secondary osteoarthritis. Thus, it may be hypothesized that early diagnosis may lead to preservation of a sufficient quantity of subchondral bone, and as a result, the rate of local recurrence may decrease and the functional outcome may improve.…”

Section: Discussionsupporting

confidence: 89%

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

et al. 2016

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Abstract. Giant cell tumor of bone (GCTB) is a primary benign bone tumor with a locally aggressive character. Definitive descriptions of the site of origin for this type of tumor are not available. The aim of the present study was to evaluate the site of origin of GCTB of long bones with regards to epiphyseal lines by means of radiographic examination. For that purpose, plain X-ray scans of 71 GCTBs arising in long bones were retrospectively reviewed. The tumor locations were the distal femur in 31 cases, proximal femur in 11 cases, proximal tibia in 13 cases, distal radius in 6 cases, proximal humerus in 5 cases and proximal fibula in 5 cases. The vertical center (VC) of the tumor was determined with X-ray anteroposterior view, and the correlation between the VC and the epiphyseal line, and between the distance from the epiphyseal line to the VC and tumor area or volume were analyzed using a regression model equation based on scatter plot diagrams. The VC of the tumor was located in the metaphyseal region in 57 cases, in the epiphyseal line in 11 cases and in the epiphyseal region in 3 cases. In cases of GCTB located in the distal femur or proximal tibia, significant correlations between the distance from the VC to the epiphyseal line and tumor area or volume were identified. The site of origin of GCTB was estimated to be located in the metaphyseal region. GCTB often occurs in mature patients, which renders it challenging to estimate the true site of origin of this lesion, since the metaphyseal line has disappeared in mature patients. The results of the present study suggest that GCTB possibly originates in the metaphyseal region. IntroductionGiant cell tumor of bone (GCTB) is a relatively uncommon primary bone tumor that exhibits an aggressive character and a high risk of local recurrence following surgery. GCTB accounts for 4-5% of all primary bone tumors and 13-20% of all benign bone tumors (1,2). These tumors frequently occur in skeletally mature persons, with a peak incidence in the third to fourth decade of life, while rarely arise in patients with an open growth plate. In addition, GCTBs display a slight female preponderance (3). The majority of GCTBs follow a benign course. However, GCTBs often exhibit local recurrence following surgery (3), and a previous study reported that pulmonary metastases develop despite the presence of benign histological features in 3% of patients with GCTB (4). GCTBs may undergo malignant transformation (3). Rock et al (5) reported that this may occur as a result of dedifferentiation of the primary tumor, or secondary to prior radiation therapy.The majority of GCTBs are located at the end of long bones, and ~50~60% of them are located around the knee, distal femur and proximal tibia, being the distal femur the bone most frequently involved (6-8).A previous study described that GCTB arises in the epiphyseal region of long tubular bones (9). The recent literature states that the majority of GCTBs exhibit a typical metaphyseal/epiphyseal location (10), whereas GCTBs may be cente...

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Section: Discussionsupporting

confidence: 89%

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

et al. 2016

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“…Although PMMA thermal necrosis has been shown to reduce local recurrence, other adjuvants have also been successful [14,18,24]. In the current study we found no difference in the proportion of patients experiencing recurrence between the two study groups.…”

Section: Discussioncontrasting

confidence: 51%

“…PMMA directly adjacent to articular cartilage may contribute to an increased risk of postoperative articular fractures and early degenerative osteoarthritis [2,8,20,24]. This study directly compares reconstruction using bone graft with or without PMMA versus PMMA alone at the same institution.…”

Section: Discussionmentioning

confidence: 99%

“…PMMA has a modulus that is between cortical bone and cancellous bone and well above articular cartilage. PMMA acts as a rigid surface, concentrating pressure on the already thin cartilage and subchondral plate tissue [13,15,24]. This may result in cartilage damage, fracture, and arthrosis [13,15,28].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the modulus of PMMA is greater than subchondral bone and cartilage [8,12,13,15,28]. PMMA directly adjacent to articular cartilage may make the patient more susceptible to postoperative articular fractures and early degenerative osteoarthritis [2,8,20,24]. Bone grafting the subchondral plate with or without supplemental PMMA may therefore be more beneficial than PMMA alone.…”

Section: Introductionmentioning

confidence: 99%

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Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

Benevenia

Rivero

Moore

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Giant cell tumors (GCTs) are treated with resection curettage and adjuvants followed by stabilization. Complications include recurrence, fracture, and joint degeneration. Studies have shown treatment with polymethylmethacrylate (PMMA) may increase the risk of joint degeneration and fracture. Other studies have suggested that subchondral bone grafting may reduce these risks. Questions/purposes Following standard intralesional resection-curettage and adjuvant treatment, is the use of bone graft, with or without supplemental PMMA, (1) associated with fewer nononcologic complications; (2) associated with differences in tumor recurrence between patients treated with versus those treated without bone grafting for GCT; and (3) associated with differences in Musculoskeletal Tumor Society (MSTS) scores? Methods Between 1996 and 2014, 49 patients presented with GCT in the epiphysis of a long bone. Six patients were excluded, four who were lost to followup before 12 months and two because they presented with displaced, comminuted, intraarticular pathologic fractures with a nonreconstructable joint surface. The remaining 43 patients were included in our study at a mean followup of 59 months (range, 12-234 months). After resection-curettage, 21 patients were reconstructed using femoral head allograft with or without PMMA (JB) and 22 patients were reconstructed using PMMA alone (FRP, KSB); each surgeon used the same approach (that is, bone graft or no bone graft) throughout the period of study. The primary study comparison was between patients treated with bone graft (with or without PMMA) and those treated without bone graft. Results Nononcologic complications occurred less frequently in patients treated with bone graft than those treated without (10% [two of 21] versus 55% [12 of 22]; odds ratio, 0.088; 95% confidence interval [CI], 0.02-0.47; p = 0.002). Patients with bone graft had increased nononcologic complication-free survival (hazard ratio, 4.59; 95% CI, 1.39-15.12; p = 0.012). With the numbers available, there was no difference in tumor recurrence between patients treated with bone graft versus without (29% [six of 21] versus 32% [seven of 22]; odds ratio, 0.70; 95% CI, 0.1936-2.531; p = 0.586) or in recurrence-free survival among patients with bone graft versus without (hazard ratio, 0.94; 95% CI, 0.30-2.98; p = 0.920). With the numbers available, there was no difference in mean MSTS scores between patients treated with bone graft versus without (92% ± 2% versus 93% ± 1.4%; mean difference 1.0%; 95% CI, À3.9% to 6.0%; p = 0.675). Conclusions Compared with PMMA alone, the use of periarticular bone graft constructs reduces postoperative complications apparently without increasing the likelihood of tumor recurrence.

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A new joint reconstruction technique in the treatment of giant cell tumors around the knee: Structural allograft and unicompartmental arthroplasty

Liu

Zhang

et al. 2023

Journal of Surgical Oncology

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ObjectiveThe long‐term prognosis of patients who underwent unicompartmental knee arthroplasty (UKA) with a structural allograft or hemiarticular allograft transplantation to treat giant cell tumors (GCTs) around the knee and the prosthesis survival rate were analyzed.MethodsWe retrospectively reviewed 73 patients who were diagnosed with GCTs around the knee and underwent surgery to restore joint function from 2000 to 2015. Patients were divided into two groups according to the surgical procedure used for functional knee reconstruction: hemiarticular allograft transplantation or structural allograft and UKA. The Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to analyze postoperative knee function between the two groups. The Kellgren‐Lawrence (K–L) classification system was used to evaluate the progression of osteoarthritis. The incidence of complications and the prosthesis survival rate were also investigated.ResultsPatients who underwent UKA to treat GCT demonstrated significantly improved knee function. The rate of an excellent or good KSS was significantly different between the two groups (p = 0.041 at the 1‐year follow‐up, p = 0.033 at the last follow‐up). The proportion of severe cases according to WOMAC in the two groups was also different (p = 0.030 at the 1‐year follow‐up, p = 0.021 at the last follow‐up). According to the K–L grade of unaffected compartments, UKA better prevented the progression of osteoarthritis (p = 0.034).ConclusionsPatients with GCTs around the knee could benefit from UKA. In addition to providing better knee function and range of motion, UKA could also slow the progression of osteoarthritis in the knee joint. This new surgical method could meet the needs of patients wishing to preserve joint integrity and favorable joint function.

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Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone

Cited by 41 publications

References 20 publications

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region

Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

A new joint reconstruction technique in the treatment of giant cell tumors around the knee: Structural allograft and unicompartmental arthroplasty

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