Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Toy, Patrick C.; Randall, R. Lor; Neel, Michael D.; Shorr, Ronald I.; Heck, Robert K.

doi:10.2106/jbjs.d.02313

Cited by 22 publications

(33 citation statements)

References 11 publications

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“…Sample size was determined based on previous studies. 11,13 We hypothesized a 1500 N difference between the groups would be clinically relevant. This study was powered so there was a 90% chance the study would reveal this difference if one existed.…”

Section: Methodsmentioning

confidence: 99%

“…We used the loading parameters from previous studies to allow comparison. 11,13 Specimens were observed for any changes or early signs of failure. The actuator position at Time 0 served as the reference point for displacement.…”

Section: Methodsmentioning

confidence: 99%

“…7,11,15 We recently examined the use of crossed screws that engaged intact bone to augment construct strength for a defect in the distal femur. 13 The addition of crossed screws to the cement mantle improved the strength and stiffness compared to constructs with cement alone and cement augmented with intramedullary Steinmann pins. However, because of differences in bone morphology, we believe it inappropriate to extrapolate the results of that study to other anatomic sites without further mechanical testing.…”

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confidence: 97%

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Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Toy

Scott

Brown

et al. 2007

Clinical Orthopaedics &Amp; Related Research

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Postoperative fracture is a well described complication following curettage and cementation of aggressive benign bone tumors. We asked whether: (1) the addition of diverging screws that engage the opposite cortex increase the strength and rigidity of the construct in the proximal tibia compared with (a) cement alone and (b) would cement with intramedullary Steinmann pins; and (2) the modes of failure be different for those constructs. The average load to failure for tibias reconstructed with cement augmented with diverging screws (6321 +/- 681 N) was higher than for tibias reconstructed with cement alone (2343 +/- 222 N). The average load to failure for tibias reconstructed with cement augmented with diverging screws (6885 +/- 445 N) was higher than for tibias reconstructed with cement and intramedullary Steinmann pins (5218 +/- 941 N). Furthermore, constructs with cement augmented with diverging screws were less likely to fail by an intraarticular fracture than other types of constructs. Our data support the use of diverging screws that engage the opposite cortex to augment the strength of the construct when using acrylic cement to fill noncontained defects after curettage of the proximal tibia. This more stable, stronger construct might allow earlier mobilization and rehabilitation after curettage, with a decreased risk of fracture.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 97%

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Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Toy

Scott

Brown

et al. 2007

Clinical Orthopaedics &Amp; Related Research

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“…The amount of reinforcement necessary is directly proportional to the amount of bone removed to expose the tumor as well as the size of the tumor itself. 17 Not all patients require hardware. The strength of the construct must also be kept in mind in determining the patients postoperative weight bearing status and activity level.…”

Section: Filling the Void After Tumor Removalmentioning

confidence: 99%

Use of the Argon Beam Coagulator as an Adjuvant for Treating Bone Tumors

DiCaprio¹,

Boyle²,

Gibbs³

2007

Techniques in Orthopaedics

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Argon beam coagulation is becoming a user-friendly, safe adjuvant for treatment of benign aggressive bone tumors, despite little scientific literature available pertaining to the use of the device for bone tumors. It is becoming a part of the orthopaedic oncologist armamentarium used in treating bone tumors with a documented high rate of local recurrence. Our goal is to discuss the literature available on this technique as it applies to other surgical fields and to demonstrate how this modality can be applied to orthopaedic surgery. Further basic science research is necessary to better understand the overall safety and efficacy of this technique when applied for bone procedures.

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“…This helps to preserve joint integrity and maximize function without resorting to endoprosthetic replacements. Postoperative fracture and cartilage loss result in degenerative changes and arthritis [2,7,17,23,27,29]. The method of skeletal reconstruction may play a role in the future biologic integrity of the joint and result in subsequent fracture and degenerative changes.…”

Section: Introductionmentioning

confidence: 99%

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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Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Abstract: In this in vitro cadaver study, augmentation of polymethylmethacrylate cement with crossed screws resulted in a stronger reconstruction of distal femoral tumor defects than that obtained with cement alone or with cement and intramedullary Steinmann pins.

Cited by 22 publications

References 11 publications

Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Use of the Argon Beam Coagulator as an Adjuvant for Treating Bone Tumors

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

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