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Tsukamoto S, Mavrogenis AF, Masunaga T, Honoki K, Fujii H, Kido A, Tanaka Y, Errani C. Current Concepts in the Treatment of Giant Cell Tumor of Bone: An Update. Curr Oncol 2024; 31:2112-2132. [PMID: 38668060 PMCID: PMC11048866 DOI: 10.3390/curroncol31040157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Curettage is recommended for the treatment of Campanacci stages 1-2 giant cell tumor of bone (GCTB) in the extremities, pelvis, sacrum, and spine, without preoperative denosumab treatment. In the distal femur, bone chips and plate fixation are utilized to reduce damage to the subchondral bone and prevent pathological fracture, respectively. For local recurrence, re-curettage may be utilized when feasible. En bloc resection is an option for very aggressive Campanacci stage 3 GCTB in the extremities, pelvis, sacrum, and spine, combined with 1-3 doses of preoperative denosumab treatment. Denosumab monotherapy once every 3 months is currently the standard strategy for inoperable patients and those with metastatic GCTB. However, in case of tumor growth, a possible malignant transformation should be considered. Zoledronic acid appears to be as effective as denosumab; nevertheless, it is a more cost-effective option. Therefore, zoledronic acid may be an alternative treatment option, particularly in developing countries. Surgery is the mainstay treatment for malignant GCTB.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece;
| | - Tomoya Masunaga
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
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Tan L, Li Y, Hu X, Lu M, Zhang Y, Gan Y, Tu C, Min L. Clinical evaluation of the three-dimensional printed strut-type prosthesis combined with autograft reconstruction for giant cell tumor of the distal femur. Front Oncol 2023; 13:1206765. [PMID: 37675226 PMCID: PMC10479807 DOI: 10.3389/fonc.2023.1206765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Propose This study aimed to describe the design and surgical techniques of a three-dimensional (3D) printed strut-type prosthesis with a porous titanium surface for distal femur giant cell tumors of bone (GCTB) and evaluate the short-term clinical outcomes. Methods From June 2018 to January 2021, 9 consecutive patients with grade I or II GCTB in the distal femur underwent extended intralesional curettage followed by 3D-printed strut-type prosthesis combined with autograft reconstruction were retrospectively reviewed to assess their clinical and radiographic outcomes. Results All patients were followed up for 30.8 ± 7.5 months (18-42 months) after surgery. The mean affected subchondral bone percentage and the mean subchondral bone thickness before surgery was 31.8% ± 9.6% (range, 18.2% ~50.2%) and 2.2 ± 0.8 mm (range, 1.2-4.0 mm), respectively. At the final follow-up, all the patients were alive without local recurrence; no postoperative complications were observed. Patients had significant improvements in postoperative MSTS-93 score [(26.7 ± 2.4) vs. (18.8 ± 3.7), P < 0.05], and ROM [(122.8° ± 9.1°) vs. (108.3° ± 6.1°), P < 0.05] compared with their preoperative statuses. Furthermore, the mean subchondral bone thickness has increased to 10.9 ± 1.3 mm (range, 9.1-12.1 mm). Conclusion 3D-printed strut-type prosthesis combined with autograft reconstruction provides acceptable early functional and radiographic outcomes in patients with grade I or II GCTB in distal femur due to the advantages of the prosthesis such as good biocompatibility, osseointegration capacity, and subchondral bone protection. If our early outcomes can be further validated in studies with more patients and sufficient follow-up, this method may be evaluated as an alternative for the treatment of grade I or II GCTB in the distal femur.
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Affiliation(s)
- Linyun Tan
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Li
- Department of Orthopedics, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiong Gan
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu, China
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Ebeid WA, Badr IT, Mesregah MK, Hasan BZ. Incidence and progression of osteoarthritis following curettage and cementation of giant cell tumor of bone around the knee: long-term follow-up. J Orthop Traumatol 2023; 24:11. [PMID: 37024720 PMCID: PMC10079796 DOI: 10.1186/s10195-023-00693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/12/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is a benign locally aggressive tumor frequently treated with intralesional curettage and cementation. The aim of this study was to investigate the long-term incidence of arthritic changes following curettage and cementation of GCTB around the knee. MATERIALS AND METHODS This study was a retrospective review of patients with GCTB around the knee treated with curettage and cementation with a minimum follow-up of 10 years. The functional results were assessed using the Musculoskeletal Tumor Society (MSTS) score. The arthritic changes were classified using the Kellgren-Lawrence (KL) classification system of osteoarthritis. RESULTS This study included 119 patients, 54 males and 65 females, with a mean age of 29.4 ± 9.2 years. There were 35 (29.4%) patients with pathological fractures. There were 84 (70.6%) patients with de novo lesions and 35 (29.4%) with recurrent lesions. The mean follow-up period was 13.2 ± 3.16 years. The mean MSTS score was 28.5 ± 1.9. Overall, 25 (21%) patients developed variable degrees of arthritis of KL grade 1 (n = 7), KL grade 2 (n = 11), KL grade 3 (n = 4), and KL grade 4 (n = 3). Ten patients showed progression of arthritis during the follow-up period. Age at presentation, gender, presence of pathological fracture, whether the tumor was de novo or recurrent, and tumor location were not associated with arthritis incidence. CONCLUSIONS Curettage and cementation can be used safely to treat GCTB around the knee. Arthritis of the knee is a possible complication, but mild grades are expected in most cases. There was no association between arthritis incidence and age, gender, pathological fractures, tumor location, or recurrent tumors. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Walid Atef Ebeid
- Department of Orthopaedic Surgery, Cairo University, Cairo, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopaedic Surgery, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | | | - Bahaa Zakarya Hasan
- Department of Orthopaedic Surgery, Menoufia University, Shebin El-Kom, Menoufia, Egypt
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Is three-dimension-printed mesh scaffold an alternative to reconstruct cavity bone defects near joints? INTERNATIONAL ORTHOPAEDICS 2023; 47:631-639. [PMID: 36629849 DOI: 10.1007/s00264-022-05684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Reconstruction of cavity bone defects after curettage of benign bone tumours around the joint remains challenging. We designed a novel 3D-printed mesh scaffold as a substitute for bone cement, aiming to support the articular surface, protect the subchondral bone, and reduce complication rates. METHODS We retrospectively analyzed seven patients who received curettage and reconstruction using a 3D-printed mesh scaffold between January 2020 and June 2021. Pain and function were evaluated using the 10-cm Visual Analogue Scale (VAS) score and the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score. Radiographs were used to evaluate articular surface supporting, subchondral bone protection, and complications. RESULTS The median functional MSTS-93 and VAS scores were both improved after surgery, and the median 3D-printed mesh scaffold volume was smaller than the median defect volume. Articular surface supporting, subchondral bone preservation, and osteogenesis were observed post-operatively. No related complications were observed during the last follow-up. CONCLUSIONS The 3D-printed mesh scaffold provided sufficient mechanical support for the articular surface and protected the subchondral bone. We recommended the 3D-printed mesh structure as an alternative to repair cavity bone defects around joints.
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Jiang X, Chen J, Zhou W, Zhang C, Wang G, Dong D, Xia P, Liu X, Xu F. Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04348-9. [PMID: 36190550 DOI: 10.1007/s00432-022-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). METHODS This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. RESULTS All patients were followed up for 21 to 110 months, with an average of 63.79 months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. CONCLUSIONS The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. LEVEL OF EVIDENCE IV: case series.
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Affiliation(s)
- Xiang Jiang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, 1023-1063 Shatai South Road, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Chen Zhang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Dan Dong
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Pingguang Xia
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China.
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
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Yuan D, Fang X, Lei S, Banskota N, Kuang F, Gou Y, Zhang W, Duan H. Case Report: Three-dimensional printed prosthesis reconstruction for patello-femoral large osteochondral defects in a patient with distal femoral giant cell tumour: A case report. Front Bioeng Biotechnol 2022; 10:995879. [PMID: 36213058 PMCID: PMC9532597 DOI: 10.3389/fbioe.2022.995879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The restoration and reconstruction of patello-femoral large osteochondral defects caused by bone tumours are challenging because of the local recurrence rate and the joint’s mechanical complexity. Although three-dimensional (3D)-printed prostheses are commonly adopted for tumour-induced bone defect reconstruction, patello-femoral osteochondral reconstruction with 3D-printed prostheses is rarely reported. Case presentation: A 44-year-old female patient with progressive swelling and pain in the left knee for 6 months was diagnosed with Campanacci Grade II giant cell tumour (GCT). She underwent intralesional curettage combined with autografting and internal fixation, after which complications of deep infection arose. The patient then underwent internal fixation removal and cement packing. Afterwards, the pain of the affected knee persisted for 11 months, and bone cement removal plus 3D-printed modular prosthesis reconstruction was performed. At the last follow-up 27 months after surgery, she was pain free, the Musculoskeletal Tumour Society (MSTS) score improved from 15/30 to 29/30, the Visual Analogue Scale (VAS) score decreased from 7 to 0, and knee flexion increased from 50° to 130°. X-ray images 22 months after surgery showed that the prosthesis and screws were in a stable position, and callus formation was found at the prosthesis-bone interface. Conclusions: A 3D-printed modular prosthesis may be a useful treatment option for the surgical reconstruction of GCT-induced patello-femoral large osteochondral defects. The firm fixation, osseointegration, and favourable congruency of the 3D-printed prosthesis with the adjacent articular surface can achieve long-term knee function and stability.
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Affiliation(s)
- Dechao Yuan
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Fang
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Senlin Lei
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Nishant Banskota
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Fuguo Kuang
- Department of Orthopedics, People’s Fourth Hospital of Sichuan Province, Chengdu, China
| | - Yawei Gou
- Department of Orthopedics, People’s Fourth Hospital of Sichuan Province, Chengdu, China
| | - Wenli Zhang
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hong Duan, ; Wenli Zhang,
| | - Hong Duan
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hong Duan, ; Wenli Zhang,
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Hu X, Lu M, Zhang Y, Wang Y, Min L, Tu C. A biomechanical comparison between cement packing combined with extra fixation and three-dimensional printed strut-type prosthetic reconstruction for giant cell tumor of bone in distal femur. J Orthop Surg Res 2022; 17:151. [PMID: 35264178 PMCID: PMC8905788 DOI: 10.1186/s13018-022-03039-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/02/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The most common reconstruction method for bone defects caused by giant cell tumor of bone (GCTB) is cement packing combined with subchondral bone grafting and extra fixation. However, this method has several limitations involving bone cement and bone graft, which may lead to poor prognosis and joint function. A titanium-based 3D-printed strut-type prosthesis, featured with excellent biocompatibility and osseointegration ability, was developed for this bone defect in our institution. The goal of this study is to comparatively analyze the biomechanical performance of reconstruction methods aimed at the identification of better operative strategy. METHODS Four different 3D finite element models were created. Model #1: Normal femur; Model #2: Femur with tumorous cavity bone defects in the distal femur; Model #3: Cavity bone defects reconstructed by cement packing combined with subchondral bone grafting and extra fixation; Model #4: Cavity bone defects reconstructed by 3D-printed strut-type prosthesis combined with subchondral bone grafting. The femoral muscle multiple forces were applied to analyze the mechanical difference among these models by finite element analysis. RESULTS Optimal stress and displacement distribution were observed in the normal femur. Both reconstruction methods could provide good initial stability and mechanical support. Stress distributed unevenly on the femur repaired by cement packing combined with subchondral bone grafting and extra fixation, and obvious stress concentration was found around the articular surface of this femur. However, the femur repaired by 3D-printed strut-type prosthetic reconstruction showed better performance both in displacement and stress distribution, particularly in terms of the protection of articular surface and subchondral bone. CONCLUSIONS 3D-printed strut-type prosthesis is outstanding in precise shape matching and better osseointegration. Compared to cement packing and extra fixation, it can provide the almost same support and fixation stiffness, but better biomechanical performance and protection of subchondral bone and articular cartilage. Therefore, 3D-printed strut-type prosthetic reconstruction combined with subchondral bone grafting may be evaluated as an alternative for the treatment of GCTBs in distal femur.
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Affiliation(s)
- Xin Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Jamshidi K, Bagherifard A, Mohaghegh MR, Mirzaei A. Fibular strut allograft or bone cement for reconstruction after curettage of a giant cell tumour of the proximal femur : a retrospective cohort study. Bone Joint J 2022; 104-B:297-301. [PMID: 35094576 DOI: 10.1302/0301-620x.104b2.bjj-2021-1322.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur. METHODS In a retrospective study, we reviewed 26 patients with a GCT of the proximal femur in whom the bone defect had been filled with either a fibular strut allograft (n = 12) or bone cement (n = 14). Their demographic details and oncological and nononcological complications were retrieved from their medical records. Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) score. RESULTS Mean follow-up was 116 months (SD 59.2; 48 to 240) for the fibular strut allograft group and 113 months (SD 43.7; 60 to 192) for the bone cement group (p = 0.391). The rate of recurrence was not significantly different between the two groups (25% vs 21.4%). The rate of nononcological complications was 16.7% in the strut allograft group and 42.8% in the bone cement group. Degenerative joint disease was the most frequent nononcological complication in the cement group. The mean MSTS score of the patients was 92.4% (SD 11.5%; 73.3% to 100.0%) in the fibular strut allograft group and 74.2% (SD 10.5%; 66.7% to 96.7%) in the bone cement group (p < 0.001). CONCLUSION Given the similar rate of recurrence and a lower rate of nononcological complications, fibular strut grafting could be recommended as a method of reconstructing the bone defect left by curettage of a GCT of the proximal femur. Cite this article: Bone Joint J 2022;104-B(2):297-301.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Zhou L, Zhu H, Lin S, Jin H, Zhang Z, Dong Y, Yang Q, Zhang C, Yuan T. Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage. INTERNATIONAL ORTHOPAEDICS 2021; 46:381-390. [PMID: 34783889 PMCID: PMC8782792 DOI: 10.1007/s00264-021-05260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA (< 2 mm), and DPC were significantly related to recurrence, as determined by multivariate logistic regression. The C-index of the final model was 0.79 (95% CI: 0.71 to 0.88), representing a good model for predicting recurrence. Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05260-6.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hanqiang Jin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhaoyuan Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
- Institute of Microsurgery On Extremities, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China.
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Soares do Brito J, Spranger A, Almeida P, Portela J, Barrientos-Ruiz I. Giant cell tumour of bone around the knee: a systematic review of the functional and oncological outcomes. EFORT Open Rev 2021; 6:641-650. [PMID: 34532071 PMCID: PMC8419793 DOI: 10.1302/2058-5241.6.200154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Giant cell tumour of bone (GCT) is a relatively rare, locally aggressive benign neoplasm observed in the long bone epiphyseal-metaphyseal regions of young adults. The optimal treatment strategy for these tumours remains controversial, and a huge amount of contradictory data regarding the functional and oncological outcomes can be found. Therefore, we performed a systematic review intended to investigate the functional and oncological outcomes after surgical treatment of GCTs arising around the knee, namely in the distal femur and proximal tibia. A trend towards better oncological control was found using wide resections, nonetheless, curettage-based techniques achieve a highly acceptable recurrence rate with overall better knee function. A slight advantage favouring proximal tibia GCTs regarding the Musculoskeletal Tumor Society (MSTS) score was also observed. Prospective studies comparing groups of more homogeneous patients, tumours, and treatment options should be developed to obtain more conclusive and definitive results regarding the optimal strategy for treating GCTs.
Cite this article: EFORT Open Rev 2021;6:641-650. DOI: 10.1302/2058-5241.6.200154
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Affiliation(s)
| | - André Spranger
- Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal
| | - Paulo Almeida
- Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal
| | - José Portela
- Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal
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Imaging following surgery for primary appendicular bone tumours. Skeletal Radiol 2021; 50:1527-1555. [PMID: 33481074 DOI: 10.1007/s00256-021-03712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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Current Concepts in the Treatment of Giant Cell Tumors of Bone. Cancers (Basel) 2021; 13:cancers13153647. [PMID: 34359548 PMCID: PMC8344974 DOI: 10.3390/cancers13153647] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary According to the 2020 World Health Organization classification, a giant cell tumor of bone is an intermediate malignant bone tumor. Denosumab treatment before curettage should be avoided due to the increased risk of local recurrence. Administration of denosumab before en bloc resection of the giant cell tumors of the pelvis and spine facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for giant cell tumors of the sacrum. Denosumab therapy with or without embolization is indicated for inoperable giant cell tumors of the pelvis, spine, and sacrum. A wait-and-see approach is recommended for lung metastases at first, then denosumab should be administered to the growing lesions. Radiotherapy is not recommended owing to the risk of malignant transformation. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant giant cell tumors of bone. Abstract The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.
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Zhang Y, Lu M, Min L, Wang J, Wang Y, Luo Y, Zhou Y, Duan H, Tu C. Three-dimensional-printed porous implant combined with autograft reconstruction for giant cell tumor in proximal tibia. J Orthop Surg Res 2021; 16:286. [PMID: 33926481 PMCID: PMC8082833 DOI: 10.1186/s13018-021-02446-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes. METHODS From December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded. RESULTS The mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively. CONCLUSION The application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Yang TH, Yang RS, Lin CP, Tseng TH. Bone Cement Implantation Syndrome in Bone Tumor Surgeries: Incidence, Risk Factors, and Clinical Experience. Orthop Surg 2020; 13:109-115. [PMID: 33274603 PMCID: PMC7862161 DOI: 10.1111/os.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. Methods This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1–2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO2 <94%) or hypotension (fall in systolic blood pressure >20%); grade II, severe hypoxia (SpO2 <88%) or hypotension (fall in systolic blood pressure >40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis. Results A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self‐limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events. Conclusion Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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15
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Iwatsu J, Watanuki M, Hayashi K, Yoshida S, Yano T, Hatori M, Hosaka M, Hagiwara Y, Itoi E. Bladder perforation by orthopedic implants 26 years after limb-sparing surgery for left proximal femoral chondrosarcoma: A case report. Int J Surg Case Rep 2020; 76:441-445. [PMID: 33207408 PMCID: PMC7586051 DOI: 10.1016/j.ijscr.2020.09.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
A patient underwent limb-sparing surgery for left proximal femoral chondrosarcoma. Bladder perforation by staples occurred 26 years after limb-sparing surgery. No reports describe staple migration into the bladder after limb-sparing surgery. Bladder injury is possible in patients with urinary symptoms after pelvic surgery. Implant complications may occur even after a long postoperative period.
Introduction The need for implant use during orthopedic surgeries has been increasing. Accordingly, increased implant failures have been reported. However, bladder perforation remains a rare complication after orthopedic surgery. Although a few reports have described bladder perforation after total hip arthroplasty, no previous studies have reported the migration of staples into the bladder after limb-sparing surgery. Presentation of case A 65-year-old patient underwent limb-sparing surgery to remove a chondrosarcoma in the left proximal thigh. Twenty-six years after surgery, a staple that had been used to fix artificial ligaments to the pubis migrated to perforate the bladder, resulting in painful urination. The staple was removed, and her symptoms improved. Discussion In this case, bladder perforation by the staple resulted in painful urination. The bladder perforation was not detected until 26 years after the initial surgery. Conclusion Our observations emphasize that implant complications may occur even after a long postoperative period, and the possibility of delayed bladder perforation from previous pelvic surgeries should be considered in patients presenting with urinary tract symptoms.
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Affiliation(s)
- Jun Iwatsu
- Department of Orthopedic Surgery, JR Sendai Hospital, 1-1-5 Itsutsubashi, Aoba-ku, Sendai, Japan
| | - Munenori Watanuki
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan.
| | - Kouu Hayashi
- Department of Orthopedic Surgery, Senen Rihu Hospital, 2-2-108, Rihu-cho, Miyagi-gun, Japan
| | - Shinichirou Yoshida
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Toshihisa Yano
- Department of Orthopedic Surgery, Tome City Hospital, 25 Hasama-cho, Tome, Japan
| | - Masahito Hatori
- Department of Orthopedic Surgery, Tohoku Kosai Hospital, 2-3-11 Kokubun-cho, Aoba-ku, Sendai, Japan
| | - Masami Hosaka
- Department of Orthopedic Surgery, Miyagi Cancer Center, 47-1 Medeshimaazanodayama, Natori, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
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Jamshidi K, Zandrahimi F, Haji Agha Bozorgi M, Arefpour AM, Bagherifard A, Al-Baseesee HH, Mirzaei A. Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:289-297. [PMID: 33001283 DOI: 10.1007/s00264-020-04836-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE For the treatment of giant cell tumour of the bone (GCTB) around the knee, preserving the native joint confers advantages over scarifying it. But, there is a controversy about the efficacy of intralesional curettage versus en bloc resection for treatment of such lesions. In this study, we compared local recurrence, functional outcomes, and complications of extended curettage and en bloc resection in these lesions. METHODS Patients with grade 3 GCTB of the distal femur or proximal tibia who were presented with a pathologic fracture and treated with either en bloc resection (n = 22) or extended curettage (n = 20) were included. The mean follow-up of the patients was 6.4 ± 1.9 years in the resection group and 5.5 ± 2.4 years in the extended curettage group. The primary outcome was a local recurrence. Secondary outcomes were limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score and rate of complications. RESULTS Local recurrence was seen in four (20%) patients of the curettage group and three (13.7%) patients of the resection group (P = 0.69). The mean MSTS score was 24 ± 1.9 in the resection group and 26.5 ± 1.3 in the curettage group (P < 0.001). The number of complications was not significantly different between the two study groups (P = 0.49). However, the number of complications that required revision surgery was significantly more in the resection group (P = 0.049). CONCLUSION In grade 3 GCTB around the knee with pathologic fracture, extended curettage results in comparable oncologic outcomes to en bloc resection, while providing better function and a lower rate of revision.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Zandrahimi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Haji Agha Bozorgi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Arefpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Araki Y, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Igarashi K, Taniguchi Y, Yonezawa H, Morinaga S, Tsuchiya H. Secondary Osteoarthritis After Curettage and Calcium Phosphate Cementing for Giant-Cell Tumor of Bone Around the Knee Joint: Long-Term Follow-up. JB JS Open Access 2020; 5:JBJSOA-D-19-00068. [PMID: 32984748 PMCID: PMC7480969 DOI: 10.2106/jbjs.oa.19.00068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Use of cement combined grafting in upper and lower extremity benign bone tumors. Jt Dis Relat Surg 2020; 31:335-340. [PMID: 32584734 PMCID: PMC7489186 DOI: 10.5606/ehc.2020.71918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/15/2019] [Indexed: 12/01/2022] Open
Abstract
Objectives
This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. Patients and methods
Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. Results
Median tumor volume was 17.2 cm3 (range, 2.8 to 139.6 cm3), median area of the cortical window was 8.3 cm2 (range, 1.6 to 28.4 cm2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). Conclusion Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.
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Chen CJ, Brien EW. Early postoperative compilations of bone filling in curettage defects. J Orthop Surg Res 2019; 14:261. [PMID: 31419993 PMCID: PMC6698034 DOI: 10.1186/s13018-019-1297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for mechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl methacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of the study is to show that good functional result can be achieved with curettage and bone filler, regardless of type. Methods A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment and placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and paresthesia. Complication rates at our single institution were compared against literature values for three study cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Z-score for two populations were used to compare our subset against literature values and between different bone filling types. Results Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which the bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate of 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any complications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had sample sizes too small for statistical comparison. Statistical comparison yielded no significant difference between complications in any of the filling groups (P = 0.411). Conclusions Some has even argued that bone defects following curettage do not require bone filling for good outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be conferred by filling large bone defects. There was no significant difference in postoperative complication rates between allograft, bone graft substitute, and PMMA when compared at our institution and with literature values. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent reconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as a suitable alternative to other bone filling modalities.
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Affiliation(s)
- Clark J Chen
- Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
| | - Earl W Brien
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
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Liu Q, Luo W, Zhang C, Liao Z, Liu Y, He H. How to optimize the therapeutic effect of free autogenous fibula graft and wrist arthroplasty for giant cell tumors of distal radius? Jpn J Clin Oncol 2019; 49:656-663. [PMID: 30941404 DOI: 10.1093/jjco/hyz045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/31/2019] [Accepted: 03/05/2019] [Indexed: 12/28/2022] Open
Abstract
AbstractObjectiveThe purpose of this study is to retrospectively analyze the clinical efficacy of free fibula autograft and wrist arthroplasty in the treatment of giant cell tumors (GCT) of distal radius.MethodsWe retrospectively reviewed 26 patients with GCT of distal radius who underwent free autogenous fibula graft and wrist arthroplasty for repairing residual defect after en-block resection. The length of the fibula graft was 8.2 cm (6–10 cm). Postoperative follow-up regularly for an mean of 66.9 months. Bone healing was assessed by radiographs, pain was assessed by Visual Analog Scale (VAS) score and limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score and disabilites of the arm, shoulder and hand (DASH) score. The range of motion (ROM) of wrist and grip strength were also evaluated.ResultThere were four males and 22 females with an mean age of 36.7 years (19–60 years); the mean length of lesions was 4.8 cm (2.3–6.6 cm); 21 primary cases and five recurrent cases; eight cases of Campanacci Grade II, 18 cases of Grade III. We had no postoperative lung metastasis and only one case had a local recurrence, three cases (11%) with subluxation of lower ulnoradial joints and five cases (19%) showed narrowing of wrist joint space. The mean postoperative VAS pain score was 0.7 ± 0.7 and grip strength retained 71% of the normal hand, MSTS score was 27.7 ± 1.1 and DASH score was 9.0 ± 3.7. The ROM of the involved wrist only slightly restricted and no donor complications. Postoperative wrist joint function was significantly improved.ConclusionStrict surgical resection boundary and solid reconstruction of wrist joint capsule are the key to achieving excellent oncological prognosis and function of distal radius GCT.
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Affiliation(s)
- Qing Liu
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Luo
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Zhang
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
| | - Zhan Liao
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Liu
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo He
- Department of Orthopeadics, Xiangya Hospital, Central South University, Changsha, China
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Lu M, Wang J, Tang F, Min L, Zhou Y, Zhang W, Tu C. A three-dimensional printed porous implant combined with bone grafting following curettage of a subchondral giant cell tumour of the proximal tibia: a case report. BMC Surg 2019; 19:29. [PMID: 30819160 PMCID: PMC6396545 DOI: 10.1186/s12893-019-0491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/19/2019] [Indexed: 02/05/2023] Open
Abstract
Background Subchondral bone is commonly affected in cases of giant cell tumour (GCT) of the proximal tibia. Numerous studies have stated that retaining a sufficient subchondral bone layer could decrease the possibilities of postoperative degenerative changes and mechanical failure of the knee joint. However, the most commonly used methods of cement packing only or cement packing combined bone grafting have some limitations regarding the protection of subchondral bone after surgery. Our paper describes our attempt to reconstruct a tumorous defect associated with the subchondral area in the proximal tibia with a three-dimensional (3D)-printed porous implant combined with bone grafting and our evaluation of the short-term outcomes. Case presentation A 42-year-old man with a Campanacci grade II GCT visited our institution for initial assessment. Radiographs showed a tumour located at the epiphyseal part of the proximal tibia, and had invaded the subchondral area. Considering that the residual subchondral bone had to be protected, we used an autograft to ensure a high integration rate between the graft and host subchondral bone. We also used three-dimensional (3D) printing technology to design and fabricate a personalized porous implant to mechanically support the graft and subchondral area and help avoid degenerative changes and mechanical failure. At the last follow-up at 29 months postoperatively, the patient had satisfactory limb function and no further damage was seen to the subchondral area and articular surface. Conclusions The 3D-printed porous implant combined bone grafting may be a feasible option in the reconstruction of defects that are close to the subchondral area following extensive intracurettage of GCTs. Moreover, it can result in good postoperative function and low complication rates. However, consistent follow-up is required to clarify its long-term outcomes.
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Affiliation(s)
- Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
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Tsukamoto S, Mavrogenis AF, Tanzi P, Leone G, Righi A, Akahane M, Kido A, Honoki K, Tanaka Y, Donati DM, Errani C. Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation. J Surg Oncol 2019; 119:864-872. [PMID: 30734307 DOI: 10.1002/jso.25391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients. MATERIALS AND METHODS We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow-up was 79.5 months (57.0-125.5 months). We evaluated local recurrence and type of surgery-related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score. RESULTS Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage. CONCLUSION Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Leone
- Department of Orthopaedic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Kido
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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