Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis

Salunke, Abhijeet Ashok; Pathak, Subodh Kumar; Shah, Jaymin; Pandit, Jyotindra; Naneria, Vinod

doi:10.1016/j.jcot.2017.07.007

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…At the same time, other recent studies have also shown that pathological fractures are not a risk factor for recurrence, and the presence of a pathological fracture should not preclude the decision to perform curettage [18]. A meta-analysis showed that it has difference in local recurrence rates, but the difference in the risk of local recurrence did not reach statistical signi cance in the wide resection group compared to curettage group [19], and the meta-analysis suggest the presence of a pathological fracture should not be only in uential factor in the decision making to perform wide resection or curettage. In our study, all patients in 3D-printed group underwent curettage before reconstruction of the articular surface, and satisfactory tumor control was achieved during the mean follow-up compared with the EPR group.…”

Section: Discussionmentioning

confidence: 95%

Retrospective Analysis of Articular Surface Defect Cases Caused by Pathological Fracture of Giant Cell Tumor of Distal Femur Treated With Three-Dimension-Printed Custom-Made Prostheses Versus Conventional Endoprosthesis Replacement: Three-Dimension-Printed Custom-Made Prostheses Have Better Function Outcome

Ji¹,

Wu²,

Yang³

et al. 2020

Preprint

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Background: Pathological fracture of the distal femur giant cell tumor (GCT) occasionally leads to articular surface defect. The conventional endoprosthesis replacement needs to remove the both condyles, and then the patients probably face lower prosthesis survival rate and multiple joint replacement, especially in young patients. The aims of this study were to evaluate the feasibility of 3D-printed custom-made prosthesis in repairing the articular surface defect at a short-term follow-up.Methods: We retrospectively reviewed fourteen patients admitted and treated from January 2012 to January 2018 with mean age of 43.9 years (range 29 to 69 years). Diagnoses were primary pathological fracture of distal femur giant cell tumor (GCT) which articular surface of one condyle is defect. 10 lesions were located in medial femoral condyle and 16 in Lateral femoral condyle. Twelve patients were treated with three-dimension-printed custom-made prosthesis to repaired of articular surface defect (3D-printed group), and the other Fourteen patients were treated with endoprosthesis replacement (EPR group). Operation time, blood loss was compared between the groups. Functional results were assessed with MSTS score. The range of motion (ROM), local recurrences and complications were statistically compared.Results: Mean Follow-up is 33.5 months (range 26 to 43 months). In the 3D-printed group, operation time and blood loss were significantly less (p < 0.05). Differences in functional outcomes of the MSTS were observed between the two groups from three-month follow-up (p < 0.05) to twenty-four-month follow-up (p < 0.05), and the score were higher in the 3D-printed group than the EPR group. The ROM of the 3D-printed group was statistically better than the EPR group at 6 and 9 months after operation (p < 0.05). Local recurrence and complication rates were similar in the two groups (p = 1).Conclusion: 3D-printed custom-made prosthesis represent a promising reconstructive technique in articular surface defect caused by pathological fracture of GCT of distal femur. It could be able to achieve satisfactory oncological and better short-term functional results compared with endoprosthesis replacement. Further studies are needed to evaluate the stability of the implants and the wear of the articular surface with larger samples at long-term.

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Section: Discussionmentioning

confidence: 95%

Retrospective Analysis of Articular Surface Defect Cases Caused by Pathological Fracture of Giant Cell Tumor of Distal Femur Treated With Three-Dimension-Printed Custom-Made Prostheses Versus Conventional Endoprosthesis Replacement: Three-Dimension-Printed Custom-Made Prostheses Have Better Function Outcome

Ji¹,

Wu²,

Yang³

et al. 2020

Preprint

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“…Although most recurrences were reported to occur within 3 yr of curettage,4,15,17–19 in rare instances the recurrence may develop many years or even decades after elimination of the original lesion 9,20–22. However, late recurrence of GCTB should arouse suspicion of increased risk of malignant transformation 23.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for local recurrence of giant cell tumor of bone of the extremities: a retrospective study

AbdelKawi

Abed

El-negery

et al. 2022

Current Orthopaedic Practice

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Background:Although considered as a benign tumor, giant cell tumor of bone (GCTB) has an aggressive biological behavior with high tendency for local recurrence (LR). The most commonly used method of treatment of GCTB is intralesional curettage augmented by various types of local adjuvants. The aim of this study was to evaluate the rate of recurrence of GCTB after surgical treatment to detect the risk factors that may influence the rate of LR. Methods:Fifty-two cases of GCTB that had been treated in a university hospital musculoskeletal oncology unit, between 2012 and 2017 were retrospectively reviewed after minimal follow-up of 4 yr and risk factors of LR were determined. Results:All LRs occurred within the first 3 yr (4 to 31 mo). Curettage was used to manage 34 patient cases, from which 11 patients (32.4%) showed LR. Only one patient (5.6%) of the 18 wide local excision patients developed recurrence. The highest recurrence rate was found among the lesions of the proximal femur. Neither the tumor volume nor the pathological grade had a significant impact on the rate of LR. The presence of soft-tissue invasion, occurrence of pathological fracture at presentation and using curettage as a method of treatment were associated with significantly higher rate of LR. Conclusions:Lesions in the proximal femur, occurrence of pathological fracture at presentation, soft-tissue invasion, and curettage as management option were found to be associated with an increased risk of LR of GCTB.

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“…24 A meta-analysis showed a difference in local recurrence rates, but the difference in the risk of local recurrence between the wide resection group and curettage group did not reach statistical significance. 25 Moreover, the meta-analysis suggested that the presence of a pathological fracture should not be the only influencing factor in the decision to perform wide resection or curettage. In our study, all patients in the 3D-printed group underwent curettage before reconstruction of the articular surface, and satisfactory tumor control was achieved during the mean follow-up compared with the TKR group.…”

Section: Discussionmentioning

confidence: 99%

Use of three-dimensional–printed custom-made prosthesis to treat unicondylar femoral defect secondary to pathological fracture caused by giant cell tumor

2021

J Int Med Res

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Objective To evaluate the short-term effectiveness of using a three-dimensional (3D)-printed custom-made prosthesis to repair unicondylar femoral defects. Methods We retrospectively reviewed 26 patients with a primary pathological fracture of the distal femur caused by a giant cell tumor. All patients had unicondylar defects involving the articular surface. Twelve patients were treated with a 3D-printed custom-made prosthesis to repair the unicondylar defect (3D-printed group). The other 14 patients were treated with total knee replacement (TKR group). The operation time, blood loss, Musculoskeletal Tumor Society score, range of motion, local recurrence, and complications were statistically compared. Results The operation time was significantly shorter and the blood loss was significantly less in the 3D-printed group than in the TKR group. The Musculoskeletal Tumor Society scores were significantly higher in the 3D-printed group than in the TKR group from 3 to 24 months postoperatively. The range of motion was significantly better in the 3D-printed group than in the TKR group at 6 and 9 months postoperatively. Conclusions 3D-printed custom-made prostheses provide better short-term functional results than does TKR.

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Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis

Cited by 7 publications

References 21 publications

Risk factors for local recurrence of giant cell tumor of bone of the extremities: a retrospective study

Use of three-dimensional–printed custom-made prosthesis to treat unicondylar femoral defect secondary to pathological fracture caused by giant cell tumor

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