Secondary Osteoarthritis After Curettage and Calcium Phosphate Cementing for Giant-Cell Tumor of Bone Around the Knee Joint

Abstract

Background: Giant-cell tumor of bone (GCTB) is a locally aggressive intermediate bone tumor with a rarely metastasizing disposition. Standard surgical treatment consists of curettage, adjuvant treatment, and augmentation with allograft, autograft, or synthetics. Polymethylmethacrylate (PMMA) has been widely used for augmentation of the bone defect; however, the hyperthermic polymerization of PMMA may cause damage to articular cartilage, and the stiffness of the material may decrease the ability of the joint to absorb shock. These properties were reported to result in secondary osteoarthritis. Calcium phosphate cement has a low degree of thermal reaction and a strength that is similar to cortical bone. The aim of the present study was to investigate the incidence of secondary osteoarthritis around the knee joint following augmentation with calcium phosphate cement. Methods: We retrospectively evaluated 19 patients with primary GCTB from 2003 to 2012. Curettage, high-speed burring, phenolization, and filling with calcium phosphate cement were performed in all patients. Radiographic evidence of osteoarthritis progression was evaluated with use of the Kellgren-Lawrence grade; the postoperative grade was compared with both the preoperative grade and the grade of the nonoperative contralateral knee at the time of the latest follow-up. The Musculoskeletal Tumor Society score and oncological outcomes at the time of the latest follow-up were evaluated. Results: At a median follow-up period of 131 months, osteoarthritic progression was observed in 5 patients (26%), of which 2 were classified as Kellgren-Lawrence grade 3 and 1 was classified as Kellgren-Lawrence grade 4. The patient with grade-4 osteoarthritis underwent total knee arthroplasty, and 1 of the patients with grade-3 osteoarthritis underwent open-wedge high tibial osteotomy. The 10-year survival rate of joint cartilage with a Kellgren-Lawrence grade of <3 was 83%. The average Musculoskeletal Tumor Society score was 29 points. GCTB recurred in 2 patients, and 1 of these patients developed pulmonary metastasis. Conclusions: The incidence of secondary osteoarthritis was low, despite the long follow-up period. Prospective investigation comparing PMMA and calcium phosphate cement is warranted to determine the relative rate of secondary osteoarthritis and the outcomes associated with the 2 different types of augmentation. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Total Knee Arthroplasty for Osteoarthritis Is Uncommon after Intralesional Curettage in Giant Cell Tumor of Bone

“…14 Araki et al reported strong functional outcomes despite presence of OA, with an average MSTS score of 29 points. 16 Although only reporting on five patients, Kito et al showed excellent function and minimal joint pain at mean follow-up of 28.1 years following distal femur GCTB curettage with PMMA. 17 In the current study, the mean postoperative MSTS score at latest follow-up was 25.1 compared with a score of 14.9 on initial presentation, confirming the functional benefit of surgical treatment of GCTB.…”

Fibular strut allograft or bone cement for reconstruction after curettage of a giant cell tumour of the proximal femur

“…27 While some studies have found an increased risk of joint degeneration with the use of cement, [27][28][29] others have failed to find such association. [30][31][32] This difference has been attributed to the quantity of subchondral bone left after curettage: if the tumour is located less than 3 mm from the joint cartilage, the rate of joint degeneration increases significantly. For this reason, Benevenia et al 28 suggested the use of sheet subchondral bone graft as an adjunct to cement augmentation to reduce the rate of postoperative arthritis in the epiphysis of a long bone.…”

Resultados da curetagem estendida com e sem aloenxerto ósseo para tumores de células gigantes de grau II no joelho. Um estudo comparativo retrospectivo

“…Araki et al conduziram o estudo de acompanhamento mais longo de avaliação do desenvolvimento de osteoartrite e a relataram em 26% dos pacientes após curetagem e cimentação. 29…”