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

Abstract

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.

Giant Cell Tumor of Bone: Review of Current Literature, Evaluation, and Treatment Options

“…Given this, some have suggested that an allograft buffer prevents thermal necrosis of the chondrocytes by the bone cement exothermic reaction. 20, 21 Benevenia et al evaluated the effectiveness of the addition of allograft between the bone cement and articular cartilage and found that this technique lowered the incidence of osteoarthritis, but did not increase the incidence of local recurrence. This use of both bone graft and bone cement around knee has been demonstrated in preventing mechanical failure.…”

Bone combined cement grafting in giant cell tumor around the knee reduces mechanical failure

“…To date, several studies indicated that less residual subchondral bone and larger area of the subchondral bone invaded by GCT were more likely to accelerate the procedure of degenerative changes in the bone [ 4 , 5 ]. Supplemental bone grafting in the subchondral bone area might reduce the degenerative development [ 6 , 7 ]. Considering that destruction of the articular cartilage and subchondral bone due to extensive curettage led to occurrence of mechanical failure; it was crucial to figure out reliable clinical measurements to predict and reduce this risk.…”

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

“…However, some authors believed that a radiolucent zone might allow micromotion between the bone and cement which might cause fractures. [ 32 33 ] For this present series, no patient in cementation group got postoperative bone fracture while one patient in bone grafting group had postoperative bone fracture. The options of fixation should be decided by the tumor location, tumor volume, Campanacci's grade, and other factors.…”