Risk factors of fracture following curettage for bone giant cell tumors of the extremities

Abstract

Background Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2–14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities. Methods This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16). Results Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8–8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3–118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8–96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2–97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1–99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7–99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7–97.3; p = 0.003). Conclusions For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.

Outcome of Reoperation for Local Recurrence Following En Bloc Resection for Bone Giant Cell Tumor of the Extremity

“…Local recurrence occurred in the bone and soft tissue of 11 (37.9%) and 18 (62.1%) patients, respectively. Curettage for local recurrence was performed in 3 of 29 patients (10.3%) with moderate cortical thinning and well-maintained bone structure [ 28 , 29 ]. Curettage was performed through a large cortical bone window using a sharp curette, and all visible tumors were removed [ 28 , 29 ].…”

“…Curettage for local recurrence was performed in 3 of 29 patients (10.3%) with moderate cortical thinning and well-maintained bone structure [ 28 , 29 ]. Curettage was performed through a large cortical bone window using a sharp curette, and all visible tumors were removed [ 28 , 29 ]. Next, curettage was performed via the cavity using a high-speed bar, followed by washing with saline to remove the entire tumor [ 28 , 29 ].…”

“…Curettage was performed through a large cortical bone window using a sharp curette, and all visible tumors were removed [ 28 , 29 ]. Next, curettage was performed via the cavity using a high-speed bar, followed by washing with saline to remove the entire tumor [ 28 , 29 ]. Phenol was applied to the cavity border using a cotton-tipped applicator and neutralized with alcohol.…”

“…Local recurrence occurred in the bone and soft tissue of 11 (37.9%) and 18 (62.1%) patients, respectively. Curettage for local recurrence was performed in 3 of 29 patients (10.3%) with moderate cortical thinning and well-maintained bone structure [28,29].…”

Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment

“…However, additional plate fixation will be considered if PMMA cement treatment is not an opinion, which increases the difficulty and the cost of surgery. 77 A new surgical technique for subchondral bone grafting combined with PMMA cement reconstruction was developed for the treatment of GCTBs, which can more adequately restore the subchondral and cancellous positions of the joint surface with minimal mechanical problems (Fig. 1).…”