How to Fill the Cavity after Curettage of Giant Cell Tumors around the Knee? A Multicenter Analysis

Zheng, Keke; Yu, Xiuchun; Hu, Yongcheng; Wang, Zhen; Wu, Sujia; Ye, Zhaoming

doi:10.4103/0366-6999.217093

Cited by 25 publications

(38 citation statements)

References 31 publications

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“…This method is simple and practical with satisfactory clinical effects 42 . The immediate stability of a tumor cavity filled with bone cement contributes to the early recovery of limb function, but bone cement filling adjacent to the articular surface may lead to painless arthritis 71 . In addition, compared with the dynamic process of bone graft reconstruction, the relatively static environment after bone cement filling is more conducive to postoperative imaging follow-up observation 71,72 .…”

Section: Recommendation 12: Microwave Ablation Of Skip Metastasis In mentioning

confidence: 99%

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Zheng¹,

Yu²,

et al. 2020

Orthopaedic Surgery

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Microwave ablation has been used to treat bone tumors in extremities for more than 30 years. With improved recognition, updated microwave equipment, and expanded clinical application, microwave ablation has recently been widely used to treat bone tumors. To standardize the application of microwave ablation in the clinical treatment of bone tumors in the limbs, research results and clinical experience involving the use of microwave ablation to treat bone tumors in the limbs have been summarized, and a clinical guideline has been designed. This guideline is aimed at providing a reliable clinical basis for indications, preoperative evaluation and decision‐making, perioperative treatment, complications, and other issues via evidence‐based medicine. Two aspects are considered—percutaneous microwave ablation and intraoperative microwave ablation of bone tumors in extremities. Ultimately, the guideline is intended to standardize treatment and improve the clinical efficacy of microwave ablation of bone tumors in extremities.

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Section: Recommendation 12: Microwave Ablation Of Skip Metastasis In mentioning

confidence: 99%

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Zheng¹,

Yu²,

et al. 2020

Orthopaedic Surgery

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“…This cement could be replaced with bone after one or two years if the GCBT shows no recurrence. In addition, chemically toxic substances (e.g., alcohol or phenol) are often added to kill the remaining GCBT cells [45].…”

Section: Curettagementioning

confidence: 99%

Denosumab for effective tumor size reduction in patients with giant cell tumors of the bone: a systematic review and meta-analysis

Yayan

2019

Preprint

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Background Denosumab is a human monoclonal antibody that is used in the successful treatment of giant cell bone tumors. These tumors are rare and, in principle, benign, but they are highly aggressive, locally advanced, and osteolytic bone tumors that can metastasize to the lungs. Denosumab is an effective treatment when these tumors cannot be surgically removed or when surgical resection is likely to lead to severe morbidity (e.g., loss of limbs or joints). The aim of this systematic review and meta-analysis was to investigate the patients with giant cell bone tumors who experienced tumor progression during treatment with denosumab and to compare them with patients who experienced reduction of their giant cell bone tumors during treatment with denosumab. Methods The Embase, Cochrane Library, and MEDLINE/PubMed databases were searched until February 28, 2018 for trials reporting the efficacy and safety of denosumab in patients with giant cell bone tumors. Results Thirty-three studies were reviewed, involving a total of 350 patients who had giant cell bone tumors and were treated with denosumab. Of the 33 studies, 67% of the patients were from open-label phase II studies, 27% from case series, and 6% from case reports. The response rate for denosumab as a treatment for giant cell bone tumors was 95.3%, with statistical significance (P < 0.0001). Osteonecrosis of the jaw was statistically the most common adverse event for denosumab treatment in open-label phase II studies (P < 0.0001). No treatment-related deaths occurred in the reviewed studies. Conclusion Cumulative evidence supports the addition of surgery to optimal medical therapy with denosumab to reduce tumor size, clinical symptoms, and mortality among patients with giant cell bone tumors.

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“…[ 8 , 9 ] This type of surgical procedure commonly includes the use of physical or surgical adjuvants following intralesional curettage, such as the employment of high-speed burring and pulse lavage to improve the effectiveness of curettage and extend the surgical margins, filling with PMMA, and the use of chemicals (hydrogen peroxide, phenol, and alcohol), resulting in a relatively low local recurrence of 0% to 12% and disease-free survival rates as high as 85%. [ 2 , 4 , 9 – 11 ] Several published medical studies have reported that extensive intralesional curettage and the application of PMMA is recommended for primary and recurrent giant-cell tumors and has the advantages of easier use, cytotoxic effects, necrotic effects on remaining tumor remnants, early detection of local recurrences at follow-up, immediate full weight bearing after surgery and stabilization of the affected joint. [ 12 , 13 ] However, despite these advantages, some scholars are concerned that the application of PMMA directly adjacent to a chondral surface, which is associated with an increased risk of thermal damage to the underlying cancellous and subchondral bone, may increase the healing time in local bone tissues.…”

Section: Introductionmentioning

confidence: 99%

“…[ 12 , 13 ] However, despite these advantages, some scholars are concerned that the application of PMMA directly adjacent to a chondral surface, which is associated with an increased risk of thermal damage to the underlying cancellous and subchondral bone, may increase the healing time in local bone tissues. [ 1 , 11 , 14 , 15 ] Additionally, the special mechanical properties of cement may affect the underlying articular cartilage and contribute to nononcologic complications, including degenerative changes in the adjacent joint and fracture. [ 11 , 16 – 18 ] In a multicenter retrospective Chinese primary bone tumor study, 136 patients with GCTB in the distal femur or proximal tibia were followed for an average of 86 months.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 , 11 , 14 , 15 ] Additionally, the special mechanical properties of cement may affect the underlying articular cartilage and contribute to nononcologic complications, including degenerative changes in the adjacent joint and fracture. [ 11 , 16 – 18 ] In a multicenter retrospective Chinese primary bone tumor study, 136 patients with GCTB in the distal femur or proximal tibia were followed for an average of 86 months. The authors found that PMMA had an elasticity modulus higher than that of cortical bone and cancellous bone and well above that of articular cartilage, which may result in cartilage damage, fracture, and arthrosis.…”

Section: Introductionmentioning

confidence: 99%

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A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee

Yao

Xie

et al. 2018

Medicine

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The vast majority of giant-cell tumors occur around the knee and characteristically affect the subchondral bone. Thermal damage to the articular cartilage arising from the application of polymethylmethacrylate (PMMA) or extensive intralesional curettage presents a challenging problem to orthopedic surgeons and patients due to compliance issues. For this reason, we developed a new subchondral bone-grafting procedure to restore massive bone defects and reduce degenerative changes in the knee.The aim of this study was to describe the novel subchondral bone-grafting procedure and evaluate clinical outcomes in patients with giant-cell tumors around the knee.This retrospective single-center study included a total of 27 patients with giant-cell tumors in the distal femur and proximal tibia admitted to our department from January 2012 to December 2015 and treated with aggressive intralesional curettage. Eleven males and 16 females were included. All cases underwent subchondral autograft bone grafting followed by bone cement reconstruction and instrument internal fixation. The Musculoskeletal Tumor Society (MSTS) score and short form-36 (SF-36) were applied to assess the functional outcome of the knee joint and quality of life. Tumor recurrence, Kellgren and Lawrence (KL) grade, and the distance of the cement to the articular surface were assessed throughout the sample.All cases were followed up after surgery for an average of 32.9 ± 7.1 months (range 25–57 months). At the end of the follow-up period, all patients were alive and free from pulmonary metastasis. Complications associated with this surgery occurred only in 1 patient (3.7%), who presented with an incision infection that resolved with regular dressing and antibiotics. No fractures, instrument breakage, or joint fluid leakage occurred. Local recurrence occurred in 1 case (3.7%) at the distal femur after 23 months and was treated by wide resection followed by prosthesis reconstruction. Twenty-four patients (89%) did not develop radiographic findings of osteoarthritis: at the final follow-up 2 patients (7.4%), had progressed to KL1 and 1 patient had progressed to KL2. According to the MSTS scoring system, the functional score of the affected knee joint at the last follow-up ranged from 80% to 97%, with an average of 87.3%. The quality of life parameters assessed by the SF-36 survey at the last follow-up ranged from 47 to 96, with an average of 77.For patients with giant-cell tumor of bone near the knee, subchondral bone grafting combined with bone cement reconstruction is recommended as a feasible and effective treatment modality.

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How to Fill the Cavity after Curettage of Giant Cell Tumors around the Knee? A Multicenter Analysis

Cited by 25 publications

References 31 publications

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities

Denosumab for effective tumor size reduction in patients with giant cell tumors of the bone: a systematic review and meta-analysis

A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee

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