Potential for thermal damage to articular cartilage by PMMA reconstruction of a bone cavity following tumor excision: A finite element study

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

“…It has been suggested that thermal damage from PMMA can contribute to postoperative degenerative changes [8,16,22,23,25,30]. When used in conjunction with PMMA, bone graft increases the distance between the exothermic reaction of PMMA and the articular cartilage, which may protect against thermal injury [3,13,21,23]. Wilkins et al suggested irrigation of the periarticular area with chilled saline as the cement cures as a method of prevention from heat necrosis [33].…”

“…Polymerization of the cement is an exothermic reaction, which results in thermal necrosis, extending the mechanical limit of curettage [2,20]. 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].…”

“…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).…”

“…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).…”

Anatomical model-based finite element analysis of the combined cryosurgical and hyperthermic ablation for knee bone tumor

“…In addition, cryosurgery is often associated with bone resection and only considered as an adjuvant technique for bone tumor treatment. The bone resection would leave defect and must be reconstructed by implants, which would lead to large injury for healthy bone and reduce the quality of life [14,15]. For a "close system" cryosurgery, in fact, only small drilling holes are needed for the cryoprobe to insert into the site of bone tumor.…”