Replacement of epiphyseal bone with methylmethacrylate: Its effect on articular cartilage

Manley, Paul A.; McKeown, Donal; Schatzker, J.; Palmer, N C; Carman, Susan

doi:10.1007/bf00381536

Cited by 26 publications

(17 citation statements)

References 19 publications

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“…Various materials have been employed in augmenting bone defects, but none have proven ideal. [1][2][3][4][5] Autogenous bone graft, considered to be a most ideal material, has been conventionally employed. However, when the osseous defect is large, it is difficult to augment it by autogenous bone alone, and furthermore, its use is restricted by donor-site morbidity and blood loss.…”

Section: Introductionmentioning

confidence: 99%

Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

Hisatome

Yasunaga

Ikuta

et al. 2001

J. Biomed. Mater. Res.

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Bone defects were created in rabbit medial femoral condyle in a model where subchondral bone was completely removed or about 2 mm of subchondral bone was maintained. Groups without augmentation and augmented with autogenous bone, polymethylmethacrylate, or calcium phosphate cement were sacrificed at 3, 12, and 24 weeks for evaluation of articular cartilage and observation of bone formation. In the model in which subchondral bone was completely removed, collapse of the subchondral bone together with exfoliation and prolapse of cartilage developed early in all cases. In the model in which 2 mm of subchondral bone was maintained, degeneration of articular cartilage developed at 12 weeks in the group augmented with polymethylmethacrylate, showing a significant difference when compared to the contralateral untreated control group. The group augmented with calcium phosphate cement did not demonstrate any evident difference from the control group. Mechanical properties after subchondral replacement did not differ between the groups augmented with polymethylmethacrylate and calcium phosphate cement, although calcium phosphate cement was considered histologically superior. Calcium phosphate cement was a reliable subchondral replacement material when the bone defect is adjacent to the articular cartilage.

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Section: Introductionmentioning

confidence: 99%

Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

Hisatome

Yasunaga

Ikuta

et al. 2001

J. Biomed. Mater. Res.

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“…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%

“…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]. Bone graft has the ability to incorporate into host bone and more adequately restore the subchondral and cancellous positions of the joint surface [7,8,32].…”

Section: Discussionmentioning

confidence: 99%

“…When the cement polymerizes directly adjacent to a chondral surface, the exothermal reaction may cause thermal necrosis to the articular chondrocytes and increase the time needed for healing in local tissues [16,19,21,23,28,30]. 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].…”

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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“…Hence, its use in lesions involving the head and neck of the femur may result in an increased chance of fractures through cement. There is also fear about long-term degeneration of articular cartilage in subchondral lesions in weight-bearing areas, 7 infection and difficulty in removing on revision procedures.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intralesional Curettage and Cementation in the Treatment of Giant Cell Tumour Around Knee and Ankle Joints

Yadav¹,

Anand²,

Shelendra³

2016

jemds

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OBJECTIVEGiant cell tumours (GCT) of bone are benign tumours with local aggressiveness that most of the time occur around the metaphyseal area of long bones, often in contact with the articular cartilage. They account for about 5% of all primary bone tumours, their treatment remains controversial because of their high recurrence rate. In this study, a series of 28 cases treated using curettage followed by bone cementation. We studied the functional benefit of this technique and its benefit in controlling the risk of recurrence. MATERIAL AND METHODSBetween 2012 and 2015, 28 patients with GCT were treated using curettage and bone cementation. Sixteen of these tumours were present at the distal femur and eight at the proximal tibia, four at distal tibia. All patients were screened preoperatively by radiological evaluation with standard X-rays which showed the characteristic soap bubble appearance and all the cases were confirmed histologically by biopsy before they were treated with curettage and bone cementation. The mean follow-up was 3 years. All patients continue to be monitored, with no patient lost to follow-up. RESULTSIn all our cases, two recurrences were observed in 3 years in patients treated with curettage and cementation procedure which required repeated curettage and cementation. We conclude that intralesional curettage and bone cement packing is one of the best treatment options for GCT lesions with less recurrence rate. KEYWORDSGiant Cell Tumour, Cement, Curettage, PMMA. Resection treats the tumour and prevents the risk of recurrence at the cost of a less desirable functional result. 3 Electrocautery, burring, phenol irrigation, cementation, cryosurgery with liquid nitrogen, selective embolisation, and radiation are considered most effective. 4,5,6 Bone cement has the advantages of preservation of dynamic stability, thus allowing rapid loading, early mobilisation and detection of recurrence with radiological observation of lysis at the cement-bone interface, the toxic properties of the methyl methacrylate monomer and the Financial or Other, Competing Interest: None. Submission 21-01-2016, Peer Review 25-08-2016, Acceptance 31-08-2016, Published 08-09-2016. Corresponding Author: Dr. Surendra Singh Yadav, A-1/17, Sector-4, Vinay Nagar, Gwalior, Madhya Pradesh. E-mail: drsurend15@gmail.com DOI: 10.14260/jemds/2016/1203 necrotic effect of the heat given off during polymerisation on the tumour cells. It can also be used at the onset of pathological fracture. We have studied the results of this method on the recurrence rate and functional outcome. The series presented includes 16 cases at the distal femur, 8 cases at the proximal tibia and 4 at distal tibia. Between 2012 and 2015, 28 patients (18 females and 10 males) with a mean age of 39 years (range 18-60), with GCT of the long bones were treated using the curettage and cementation technique. Diagnosis was based on histological examination of biopsy material taken before any therapeutic act in all cases. It was a prospective study, an...

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Replacement of epiphyseal bone with methylmethacrylate: Its effect on articular cartilage

Cited by 26 publications

References 19 publications

Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

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

Effect of Intralesional Curettage and Cementation in the Treatment of Giant Cell Tumour Around Knee and Ankle Joints

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