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Todi N, Hiltzik DM, Moore DD. Giant cell tumor of bone and secondary osteoarthritis. Heliyon 2024; 10:e30890. [PMID: 38807896 PMCID: PMC11130671 DOI: 10.1016/j.heliyon.2024.e30890] [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: 10/27/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumor of bone is a commonly encountered aggressive epiphyseal bone tumor, most often treated surgically. The natural history and presentation are classically described but the histopathology is poorly understood. Intralesional curettage is the mainstay of treatment, but there is significant variation in the use of adjuvant and cavity filling modalities. No gold standard has been agreed upon for treatment, and a variety of techniques are currently in use. Given its location, secondary osteoarthritis is a known long-term complication. This review examines the natural history of giant cell tumors, treatment options and complications, and subsequent development of osteoarthritis. Arthroplasty is usually indicated for secondary osteoarthritis although data is limited on its efficacy. Further directions will likely center on improved pharmacological treatments as well as improved arthroplasty techniques.
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Affiliation(s)
- Niket Todi
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - David M. Hiltzik
- Northwestern University, Department of Orthopaedic Surgery, 303 E Superior St, Chicago, IL, 60611, USA
| | - Drew D. Moore
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Department of Orthopaedic Surgery, 586 Pioneer Dr, Rochester, MI, 48309, USA
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2
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Gyemi L, Selznick A, Petrisor B, Ghert M. Time to full weight-bearing with the use of a calcium sulfate-calcium phosphate bone substitute as a bone void filler following extended curettage in the treatment of primary benign bone tumours. J Orthop Surg (Hong Kong) 2024; 32:10225536241254200. [PMID: 38733211 DOI: 10.1177/10225536241254200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
PURPOSE The primary objective of this study was to determine time to full weight-bearing after the use of a calcium-sulfate-calcium phosphate bone substitute (CaSO4/CaPO4) as a bone void filler in the treatment of primary benign bone tumours following intralesional curettage. The secondary objectives were to determine surgical complications and recurrence rates. METHODS Retrospective review of patients identified from a surgeon-specific orthopaedic oncology database, who underwent curettage of benign bone tumours and subsequent bone void filling with CaSO4/CaPO4. RESULTS A total of 39 patients (20 males, 19 females) met inclusion criteria with an average age of 31 years (range: 13 to 62 years), a median follow-up of 3.7 years, and a maximum follow-up of 11 years. The most common tumour diagnosis was giant cell tumour of bone (GCT) (n = 19), and the most common location was the proximal tibia (n = 9). The mean volume of tumour excised was 74.1 cm3 including extraosseous bone expansion due to tumour growth, with a mean of volume of 21.4 mL of CaSO4/CaPO4 used to fill the intraosseous cavitary defects to restore normal bone anatomy. None of the lesions required additional internal fixation. The primary outcome measure, average time to full weight-bearing/full range of motion, was 11 weeks and 6 weeks for upper and lower extremity lesions, respectively. Secondary outcomes included tumour recurrence requiring reoperation in five patients and infection requiring reoperation in two patients. CONCLUSION This study demonstrates that CaSO4/CaPO4 is a viable option as a bone void filler in the reconstruction of cavitary defects following removal of primary benign bone tumours. CaSO4/CaPO4 provides sufficient bone regeneration early in the post-operative period to allow progression to full weight-bearing within weeks without the need for internal fixation. There were no graft-specific complications noted.
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Affiliation(s)
- Lauren Gyemi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Asher Selznick
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brad Petrisor
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Orthopaedics, University of Maryland, Baltimore, MD, USA
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Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
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Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
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Colding-Rasmussen T, Horstmann PF, Jørgensen PH, Hettwer W, Hansen BH, Tierp-Wong CNE, Petersen MM. Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231202155. [PMID: 37688488 DOI: 10.1177/10225536231202155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Polymethyl-methacrylate cement (PMMA) is often used as bone defect reconstruction material after surgical removal of giant cell tumors. The purpose of this study was to investigate if the application of PMMA improves the local recurrence rates for giant cell tumors (GCT) of appendicular bone treated with intralesional curettage. METHODS A retrospective analysis of all appendicular GTCs treated at two major Danish sarcoma centres between the 1st of January 1998 and December 31st 2013; minimum follow-up of 3.0 years (median: 8.9; 1.3-18.7 years). Kaplan-Meier survival model, log-rank and multivariate Cox regression were used to calculate and compare local recurrence rates. p-values <0.05 were considered statistically significant. RESULTS 102 patients (M59/F43), median age 31Y (11-84) were included in this study. The overall 3-years local recurrence-rate was 19.9% (95%CI: 11.9-27.9%); 91% had occurred within 3 years. In patients treated with intralesional curettage (n = 64), the 3-years recurrence-rate was 30.6% (95%CI: 18.8-42.4%), compared to 2.6% (95%CI: 0.0-7.8%) in patients treated with wide resection or amputation (n = 38), p < .001. The 3-years recurrence-rate for patients treated with intralesional curettage and reconstruction using PMMA was 29.0% (95%CI: 12.6-45.4%) and without PMMA: 31.8% (95%CI: 15.2-48.4%), p = .83. CONCLUSION We found that the use of PMMA for bone defect reconstruction after intralesional curettage of GTCs in the appendicular skeleton did not ensure a reduced risk of local recurrence.
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Affiliation(s)
| | - Peter F Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter H Jørgensen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Werner Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne H Hansen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael M Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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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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Stoops K, Brown JM, Santoni B, Groundland J. Thermal properties of polymethyl methacrylate vary depending on brand and type. J Orthop Res 2023; 41:614-618. [PMID: 35634870 DOI: 10.1002/jor.25389] [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: 02/12/2022] [Revised: 04/27/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
Polymethyl methacrylate (PMMA) is commonly used in orthopedic surgery and has several applications, most often for fixation of arthroplasty components. While its overall safety and tolerance are well described, less is known regarding the thermal properties of PMMA as it sets from a liquid to solid state, as well as the potential for osseous thermal necrosis. This study addresses potential variations in the setting time and maximum temperature of PMMA formulations in common use and explores the potential clinical implications of this variability. Seven commercially available formulations of PMMA that varied by brand and/or viscosity were obtained and prepared according to manufacturer's instructions. Peak temperature and duration were measured in controlled settings for each type and compared to previously described thresholds for thermal bone necrosis. Depuy SmartSet (HV), Zimmer Palacos R (HV), and Zimmer Palacos (LV) exceeded the 56°C threshold reported to potentially induce immediate osseous thermal necrosis. Additionally, Biomet Cobalt (MV) and Stryker Simplex P (MV) had lower peak temperatures but exceeded thermal necrosis thresholds due to curing duration. The lowest peak temperature was observed for Smith & Nephew Versabond (MV), which was significantly lower than all types except Depuy SmartSet (MV). Setting time was not significantly different among groups. There are significant differences in the thermal properties of PMMA formulations in current use. Selection of specific PMMA formulations represents an additional route of procedural optimization depending on the needs of the treating surgeon.
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Affiliation(s)
- Kyle Stoops
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Jeffrey Mark Brown
- University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Orthopedics, Sarcoma Service, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Santoni
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | - John Groundland
- Department of Orthopedics, Sarcoma Service, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Balcioglu S, Noma SAA, Ulu A, Karaaslan-Tunc MG, Ozhan O, Koytepe S, Parlakpinar H, Vardi N, Colak MC, Ates B. Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure. ACS APPLIED MATERIALS & INTERFACES 2022; 14:41819-41833. [PMID: 36066351 PMCID: PMC9501797 DOI: 10.1021/acsami.2c14078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 06/09/2023]
Abstract
The use of wire cerclage after sternal closure is the standard method because of its rigidity and strength. Despite this, they have many disadvantages such as tissue trauma, operator-induced failures, and the risk of infection. To avoid complications during sternotomy and promote tissue regeneration, tissue adhesives should be used in post-surgical treatment. Here, we report a highly biocompatible, biomimetic, biodegradable, antibacterial, and UV-curable polyurethane-acrylate (PU-A) tissue adhesive for sternal closure as a supportive to wire cerclage. In the study, PU-As were synthesized with variable biocompatible monomers, such as silk sericin, polyethylene glycol, dopamine, and an aliphatic isocyanate 4,4'-methylenebis(cyclohexyl isocyanate). The highest adhesion strength was found to be 4322 kPa, and the ex vivo compressive test result was determined as 715 kPa. The adhesive was determined to be highly biocompatible (on L-929 cells), biodegradable, and antibacterial (on Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus bacteria). Finally, after opening the sternum of rats, the adhesive was applied to bond the bones and cured with UV for 5 min. According to the results, there was no visible inflammation in the adhesive groups, while some animals had high inflammation in the cyanoacrylate and wire cerclage groups. These results indicate that the adhesive may be suitable for sternal fixation by preventing the disadvantages of the steel wires and promoting tissue healing.
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Affiliation(s)
- Sevgi Balcioglu
- Department
of Medicinal Laboratory, Sakarya University
of Applied Sciences, 54000 Sakarya, Turkey
| | - Samir Abbas Ali Noma
- Faculty
of Arts and Sciences, Department of Chemistry, Bursa Uludaǧ University, 16059 Bursa, Turkey
| | - Ahmet Ulu
- Faculty
of Arts and Sciences, Department of Chemistry, İnönü University, 44210 Malatya, Turkey
| | | | - Onural Ozhan
- Medical
Faculty, Department of Medicinal Pharmacology, İnönü University, 44210 Malatya, Turkey
| | - Suleyman Koytepe
- Faculty
of Arts and Sciences, Department of Chemistry, İnönü University, 44210 Malatya, Turkey
| | - Hakan Parlakpinar
- Medical
Faculty, Department of Medicinal Pharmacology, İnönü University, 44210 Malatya, Turkey
| | - Nigar Vardi
- Medical
Faculty, Department of Histology and Embryology, İnönü University, 44210 Malatya, Turkey
| | - Mehmet Cengiz Colak
- Medical Faculty,
Department of Cardiovascular Surgery, İnönü
University, 44210 Malatya, Turkey
| | - Burhan Ates
- Faculty
of Arts and Sciences, Department of Chemistry, İnönü University, 44210 Malatya, Turkey
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Wang Z, Nogueira LP, Haugen HJ, Van Der Geest ICM, de Almeida Rodrigues PC, Janssen D, Bitter T, van den Beucken JJ, Leeuwenburgh SCG. Dual-functional porous and cisplatin-loaded polymethylmethacrylate cement for reconstruction of load-bearing bone defect kills bone tumor cells. Bioact Mater 2022; 15:120-130. [PMID: 35386344 PMCID: PMC8941180 DOI: 10.1016/j.bioactmat.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant bone tumors are usually treated by resection of tumor tissue followed by filling of the bone defect with bone graft substitutes. Polymethylmethacrylate (PMMA) cement is the most commonly used bone substitute in clinical orthopedics in view of its reliability. However, the dense nature of PMMA renders this biomaterial unsuitable for local delivery of chemotherapeutic drugs to limit the recurrence of bone tumors. Here, we introduce porosity into PMMA cement by adding carboxymethylcellulose (CMC) to facilitate such local delivery of chemotherapeutic drugs, while retaining sufficient mechanical properties for bone reconstruction in load-bearing sites. Our results show that the mechanical strength of PMMA-based cements gradually decreases with increasing CMC content. Upon incorporation of ≥3% CMC, the PMMA-based cements released up to 18% of the loaded cisplatin, in contrast to cements containing lower amounts of CMC which only released less than 2% of the cisplatin over 28 days. This release of cisplatin efficiently killed osteosarcoma cells in vitro and the fraction of dead cells increased to 91.3% at day 7, which confirms the retained chemotherapeutic activity of released cisplatin from these PMMA-based cements. Additionally, tibias filled with PMMA-based cements containing up to 3% of CMC exhibit comparable compressive strengths as compared to intact tibias. In conclusion, we demonstrate that PMMA cements can be rendered therapeutically active by introducing porosity using CMC to allow for release of cisplatin without compromising mechanical properties beyond critical levels. As such, these data suggest that our dual-functional PMMA-based cements represent a viable treatment option for filling bone defects after bone tumor resection in load-bearing sites. Dual-functional porous PMMA cements are developed by introducing CMC as both pore generator and drug vehicle for cisplatin. PMMA-based cements containing ≥3% CMC release sufficient amounts of chemotherapeutically active cisplatin. PMMA-based cements containing ≤3% CMC retain sufficient mechanical properties for bone reconstruction at load-bearing sites.
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Affiliation(s)
- Zhule Wang
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Liebert Parreiras Nogueira
- University of Oslo, Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, Oslo, Norway
| | - Håvard Jostein Haugen
- University of Oslo, Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, Oslo, Norway
| | - Ingrid CM. Van Der Geest
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Dennis Janssen
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Thom Bitter
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jeroen J.J.P. van den Beucken
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Sander CG. Leeuwenburgh
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
- Corresponding author. Dept. of Dentistry - Regenerative Biomaterials (309), Radboudumc. Philips van Leydenlaan 25, 6525EX, Nijmegen, the Netherlands. http://www.regenerative-biomaterials.nl
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Poudel RR, Tiwari A, Jain A, Verma V. Salvaging the Unsalvageable Giant Cell Tumors of Bone: The ‘Longitudinal Sandwich Technique’. Indian J Surg Oncol 2022; 13:316-321. [DOI: 10.1007/s13193-022-01545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
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Yuan Y, Liu Q, Liu Y, Wu Z, Zhong W, He H, Luo W. Comparative Analysis of Two Surgical Treatment Options for Giant Cell Tumor of the Proximal Femur: Extended Curettage and Segmental Resection. Front Oncol 2021; 11:771863. [PMID: 34988016 PMCID: PMC8720996 DOI: 10.3389/fonc.2021.771863] [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: 09/07/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
AimAs a locally destructive intermediate bone tumor with low incidence, high recurrence rate, and difficulty in reconstruction, giant cell tumor of bone (GCTB) in the proximal femur has no unified surgical treatment standard. This study aimed to compare the differences in local recurrence, reconstruction durability, and postoperative function after treatment with either extended curettage (EC) or segmental resection (SR) for GCTB in the proximal femur so as to provide constructive suggestions for the rational selection of EC or SR operation scheme.Patients and Methods29 patients (15 men and 14 women) were included in this retrospective study, with a mean age of 32.1 years. According to the division method of proximal femur of International Society Of Limb Salvage (ISOLS), there was 1 case in the H1 area, 17 cases in the H2 area, 10 cases in the H1+H2 area, and 1 case in the H1+H2+H3 area. Among them were 11 cases of Campanacci grade II GCTB, 18 cases of Campanacci grade III GCTB, and 7 cases with pathological fractures. All patients underwent either EC or SR surgery. The Musculoskeletal Tumor Society (MSTS) score was used for patient evaluation. The operation effectiveness was analyzed according to the Mankin evaluation standard. Regular follow-up was performed to evaluate the recurrence rate, limb function, and long-term complications of the two surgical methods.ResultsAll patients were followed up for a mean of 60.4 months. Local recurrence occurred in one of 19 patients treated with EC (5.3%) and one of 10 patients treated with SR (10%). The MSTS score of lower limb function in patients in the EC group was better compared to patients in the SR group (P = 0.002). Complications occurred in 2 cases (10.5%) and 5 cases (50%) in the EC group (osteoarthritis, osteonecrosis) and SR group (joint stiffness, infection, prosthesis loosening), respectively, with significant differences between the two groups (P = 0.03). The operation effectiveness was analyzed according to the Mankin evaluation standard. The EC group showed an optimal rate of 94.7% (18/19) as opposed to 80% (8/10) in the SR group.ConclusionsFor GCTB in the proximal femur, when the tumor does not extensively involves the surrounding soft tissues, the articular surface was not damaged, and there is no pathological fracture with apparent displacement, EC surgery should be fully considered.
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Affiliation(s)
- Yuhao Yuan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ziyi Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- *Correspondence: Wei Luo,
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Phull SS, Yazdi AR, Ghert M, Towler MR. Bone cement as a local chemotherapeutic drug delivery carrier in orthopedic oncology: A review. J Bone Oncol 2021; 26:100345. [PMID: 33552885 PMCID: PMC7856326 DOI: 10.1016/j.jbo.2020.100345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Metastatic bone lesions are common among patients with advanced cancers. While chemotherapy and radiotherapy may be prescribed immediately after diagnosis, the majority of severe metastatic bone lesions are treated by reconstructive surgery, which, in some cases, is followed by postoperative radiotherapy or chemotherapy. However, despite recent advancements in orthopedic surgery, patients undergoing reconstruction still have the risk of developing severe complications such as tumor recurrence and reconstruction failure. This has led to the introduction and evaluation of poly (methyl methacrylate) and inorganic bone cements as local carriers for chemotherapeutic drugs (usually, antineoplastic drugs (ANPDs)). The present work is a critical review of the literature on the potential use of these cements in orthopedic oncology. While several studies have demonstrated the benefits of providing high local drug concentrations while minimizing systemic side effects, only six studies have been conducted to assess the local toxic effect of these drug-loaded cements and they all reported negative effects on healthy bone structure. These findings do not close the door on chemotherapeutic bone cements; rather, they should assist in materials selection when designing future materials for the treatment of metastatic bone disease.
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Affiliation(s)
- Sunjeev S. Phull
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton L8V 5C2, Ontario, Canada
| | - Mark R. Towler
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
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Ke J, Cheng S, Yao MY, Chu X, Wang M, Zeng XL, Yang T, Zhang C, Zhong H, Zhang Y. Novel Strategy of Curettage and Adjuvant Microwave Therapy for the Treatment of Giant Cell Tumor of Bone in Extremities: A Preliminary Study. Orthop Surg 2021; 13:185-195. [PMID: 33442922 PMCID: PMC7862174 DOI: 10.1111/os.12865] [Citation(s) in RCA: 6] [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: 05/11/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives To evaluate whether curettage with adjuvant microwave therapy was successful in the treatment of giant cell tumor of the bone (GCTB) in extremities, especially for GCTB with pathological fractures and GCTB of the distal radius. Methods This was a retrospective study of 54 cases of GCTB of the extremities treated by curettage with adjuvant microwave therapy between 2007 and 2019. Five patients were lost to follow up and excluded from the study. A total of 33 male and 21 female patients were included in this study. Patients were aged 15–57 years (mean 29.72 ± 10.48 years). Among these patients, there were 10 cases of GCTB with pathological fractures and eight cases of GCTB of the distal radius; one of these cases was combined with a pathological fracture. Comprehensive imaging examinations (X‐rays [including lesion site and chest], CT, MRI, emission computed tomography, and pathology examination) of all patients were reviewed. The clinical staging of these patients were evaluated radiologically using the Campanacci classification system based on the extent of spread of the tumor. All patients underwent curettage with adjuvant microwave therapy. Clinical and imaging evaluations were performed in all cases to check for recurrence or metastasis. Lower limb and upper limber function were assessed using the Musculoskeletal Tumor Society score (MSTS), and wrist function was assessed according to the disabilities of the arm, shoulder and hand (DASH) score. Data on surgical‐related complications were recorded. Results All cases were followed up for 24–126 months (mean 60.69 ± 29.61 months). There were 24 patients with a Campanacci grade of 3 and 30 with a Campanacci grade of 2. The 52 patients were continuously disease‐free. The local recurrence rate was 3.70% (2 patients). One patient had recurrence in the proximal femur, and the other developed in soft tissue of the calf muscle. No recurrence occurred for GCTB of the distal radius. One recurrence occurred in a GCTB with pathological fractures. The intervals were 9 and 28 months, respectively. The cases of recurrence all had a Campanacci grade of 3 (8.33%). The median MSTS among the 54 patients was 27.67 ± 3.81. The mean wrist function DASH score was 8.30 ± 2.53. The mean MSTS was 28.67 ± 1.63 and 26.71 ± 5.49 for patients with GCTB of the distal radius and for those with pathological fractures, respectively. In comparing patients with and without pathological fractures, there was no significant difference in the MSTS functional score. Five patients had complications after the surgery. Conclusion Curettage with adjuvant microwave ablation therapy provided favorable local control and satisfactory functional outcomes in the treatment of GCTB, especially for cases with pathological fractures and those with GCTB of the distal radius.
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Affiliation(s)
- Jin Ke
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Meng-Yu Yao
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Chu
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ming Wang
- Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Xiao-Long Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chi Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hua Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Singaravadivelu V, Kavinkumar V. Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts. Malays Orthop J 2020; 14:42-49. [PMID: 33403061 PMCID: PMC7752021 DOI: 10.5704/moj.2011.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage. Materials and Methods: This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score. Results: There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%. Conclusion: Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.
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Affiliation(s)
- V Singaravadivelu
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
| | - V Kavinkumar
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
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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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18
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Şirin E, Akgülle AH, Topkar OM, Sofulu Ö, Baykan SE, Erol B. Mid-term results of intralesional extended curettage, cauterization, and polymethylmethacrylate cementation in the treatment of giant cell tumor of bone: A retrospective case series. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:524-529. [PMID: 33155564 DOI: 10.5152/j.aott.2020.19082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to present the mid-term functional outcomes and recurrence rate in patients with giant cell tumor of bone (GCTB) treated by intralesional extended curettage, electrocauterization, and polymethylmethacrylate (PMMA) cementation. METHODS In this retrospective observational study, 79 consecutive patients (41 females, 38 males; mean age=39 years; age range=19-62 years) who were diagnosed and treated for GCTB between 2005 and 2017 were identified from hospital medical records. All patients were treated by intralesional extended curettage using high-speed burr, electrocauterization of the cavity, and filling the defect with PMMA. No additional local adjuvants were used. The mean follow-up period was 47 months (range=24-96). The tumors were graded according to the radiological classification system described by Campanacci. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS) preoperatively, one year postoperatively, and at the final follow-up. Postoperative complications and recurrence rates were recorded. RESULTS Twenty-nine tumors were located in the distal femur, 23 in the proximal tibia, nine in the distal radius, five in the proximal humerus, five in the pelvis, three in the proximal fibula, two in the distal ulna, two in the distal tibia, and one in the second metatarsal. According to Campanacci classification, 37 tumors were grade III, 32 grade II, and 10 grade I. The mean MSTS score was 46.1% (range 40.2 to 71.4%) preoperatively, 91.7% (range 73.3% to 100%) one year postoperatively, and 86.3 % (range 66.2% to 96,1%) at the final follow-up. The overall complication rate was 7.6%; which included local tumor recurrence in four patients, superficial wound infection in one, and deep wound infection in another. The recurrence rate was 5.1% (4 patients). Recurrent tumors were located at the distal femur in three patients and proximal tibia in one. CONCLUSION With satisfactory functional results and low recurrence rates at the mid-term follow-up, GCTB can be treated effectively with intralesional extended curettage, electrocauterization, and PMMA cementation. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Evrim Şirin
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Osman Mert Topkar
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Ömer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Said Erkam Baykan
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Bülent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
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19
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He H, Zeng H, Luo W, Liu Y, Zhang C, Liu Q. Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection? Front Oncol 2019; 9:946. [PMID: 31608235 PMCID: PMC6769105 DOI: 10.3389/fonc.2019.00946] [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: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
Aims: This study aimed to compare and evaluate the oncological and functional prognosis of two surgical approaches for giant cell tumor of the bone (GCTB) around the knee joint and provide worthy suggestion for clinical treatment. Patients and Methods: This study included 93 patients, who were divided into the extended curettage (EC) group and segmental resection (SR) group. Relevant preoperative and postoperative data were collected, oncological and functional prognosis were evaluated, and postoperative complications of the two groups were analyzed. Local recurrence was assessed via clinical and radiological tests. Functional prognosis was evaluated using the Musculoskeletal tumor Society (MSTS) scoring system. Results: The EC group had 69 patients; it included 57 primary cases and 12 recurrent cases. The SR group had 24 patients (12 men and 12 women; mean age, 34.9 years), including 15 primary cases and 9 recurrent cases. In this study, six cases (6.5%; EC group, 5 cases; SR group 1 case) recurred within 18 months postoperatively. There was a significant difference in the mean MSTS score between the two groups (p < 0.001). Nononcologic complications occurred frequently in the EC group than in the SR group (28.0 vs. 16.7%), but no complications had serious consequences, and the functional prognosis was not affected. Conclusion: EC and SR for GCTB around the knee joint can achieve satisfactory oncological prognosis, but we should individually select the most suitable surgical method according to Campanacci grade, age, and long-term complications of patients and consider the functional prognosis to ensure excellent oncological prognosis.
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Affiliation(s)
- Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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20
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Murphy TA, Mathews JA, Whitehouse MR, Baker RP. Investigation of thermally induced damage to surrounding nerve tissue when using curettage and cementation of long bone tumours, modelled in cadaveric porcine femurs. Arch Orthop Trauma Surg 2019; 139:1033-1038. [PMID: 30715569 PMCID: PMC6647233 DOI: 10.1007/s00402-019-03129-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Curettage with cement augmentation is a technique used in the treatment of bone tumours. Thermal energy released during the cement polymerisation process can damage surrounding tissues. This study aims to record temperature changes at various sites on and around bone during the cementing process. We hypothesised that adjacent structures, such as the radial nerve, may be threatened by this process in the clinical setting. MATERIALS AND METHODS Using 18 porcine femurs as a model of the human humerus, we used thermocouples and a thermal imaging camera to measure changes in temperature during the cementing process. Fractures were created in nine samples to establish whether a discontinuity of the cortex had an effect on thermal conduction. RESULTS Significantly higher temperatures were recorded in samples with a fracture compared to those without a fracture. The site overlying the centre of the cement bolus (hypothetical site of the radial nerve) demonstrated higher temperatures than all other sites on the same cortex. When considering the radial nerve site, over half the samples demonstrated temperatures exceeding 47 °C for over a minute. When a threshold of 50 °C for more than 30 s was considered, three samples without a fracture exceeded this value compared to two with a fracture. CONCLUSION The temperatures recorded were sufficient to cause damage to neural tissue. Limiting thermal exposure to soft tissues is recommended. Increased attention is required when using larger cement boluses, or where bone quality is poor or a fracture, iatrogenic or preexisting, is present.
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Affiliation(s)
- T. A. Murphy
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
| | - J. A. Mathews
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
| | - M. R. Whitehouse
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK ,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, 1st Floor Learning and Research Building, Bristol, BS10 5NB UK ,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - R. P. Baker
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
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Wu M, Yao S, Xie Y, Yan F, Deng Z, Lei J, Cai L. A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee: A retrospective study of 27 cases. Medicine (Baltimore) 2018; 97:e13154. [PMID: 30407342 PMCID: PMC6250490 DOI: 10.1097/md.0000000000013154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The vast majority of giant-cell tumors occur around the knee and characteristically affect the subchondral bone. Thermal damage to the articular cartilage arising from the application of polymethylmethacrylate (PMMA) or extensive intralesional curettage presents a challenging problem to orthopedic surgeons and patients due to compliance issues. For this reason, we developed a new subchondral bone-grafting procedure to restore massive bone defects and reduce degenerative changes in the knee.The aim of this study was to describe the novel subchondral bone-grafting procedure and evaluate clinical outcomes in patients with giant-cell tumors around the knee.This retrospective single-center study included a total of 27 patients with giant-cell tumors in the distal femur and proximal tibia admitted to our department from January 2012 to December 2015 and treated with aggressive intralesional curettage. Eleven males and 16 females were included. All cases underwent subchondral autograft bone grafting followed by bone cement reconstruction and instrument internal fixation. The Musculoskeletal Tumor Society (MSTS) score and short form-36 (SF-36) were applied to assess the functional outcome of the knee joint and quality of life. Tumor recurrence, Kellgren and Lawrence (KL) grade, and the distance of the cement to the articular surface were assessed throughout the sample.All cases were followed up after surgery for an average of 32.9 ± 7.1 months (range 25-57 months). At the end of the follow-up period, all patients were alive and free from pulmonary metastasis. Complications associated with this surgery occurred only in 1 patient (3.7%), who presented with an incision infection that resolved with regular dressing and antibiotics. No fractures, instrument breakage, or joint fluid leakage occurred. Local recurrence occurred in 1 case (3.7%) at the distal femur after 23 months and was treated by wide resection followed by prosthesis reconstruction. Twenty-four patients (89%) did not develop radiographic findings of osteoarthritis: at the final follow-up 2 patients (7.4%), had progressed to KL1 and 1 patient had progressed to KL2. According to the MSTS scoring system, the functional score of the affected knee joint at the last follow-up ranged from 80% to 97%, with an average of 87.3%. The quality of life parameters assessed by the SF-36 survey at the last follow-up ranged from 47 to 96, with an average of 77.For patients with giant-cell tumor of bone near the knee, subchondral bone grafting combined with bone cement reconstruction is recommended as a feasible and effective treatment modality.
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Giant cell tumor of the distal femur: Outcome beyond 20 years of follow-up after curettage with polymethylmethacrylate. J Orthop Sci 2018; 23:1051-1055. [PMID: 30031709 DOI: 10.1016/j.jos.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/07/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Polymethymethacrylate (PMMA) is often used to reconstruct defects after curettage of Giant Cell Tumors (GCT). While GCTs usually originate in the epiphysis, the use of PMMA in distal femoral lesions may induce the risk of degenerative osteoarthritis (OA). We investigated the limb function of patients after curettage with PMMA beyond 20 years of follow-up. METHODS Patients with more than 20 years of follow-up who underwent curettage with PMMA for distal femoral GCTs were observed. We retrospectively investigated the radiographic assessment of OA and functional assessment of the limb. The Kellgren and Lawrence (KL) grading system was used for radiographic evaluation. RESULTS Five patients were included in this study. The mean age was 33 years, and the mean period from application of PMMA to final follow-up observation was 28.1 years. Four lesions were primary, and one lesion was recurrent. There were no patients with postoperative recurrence. There were no OA changes in preoperative radiographs. The shortest mean distance from PMMA to the articular cartilage was 4.6 mm on radiographs immediately after surgery. On radiographs at final follow-up observation, the KL grading were as follows: grade 1, 2 patients; grade 2, 1 patient; grade 3, 2 patients. All patients were able to independently ambulate without a crutch, and there was not enough pain to require nonsteroidal anti-inflammatory drugs. The mean flexion of the knee joint was 116°. CONCLUSIONS Although PMMA used for distal femoral GCTs exhibited OA changes beyond a 20 year follow-up period, there were no cases requiring artificial joints, and the affected limbs demonstrated good function.
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Martínez-Moreno J, Merino V, Nácher A, Rodrigo JL, Climente M, Merino-Sanjuán M. Antibiotic-loaded Bone Cement as Prophylaxis in Total Joint Replacement. Orthop Surg 2018; 9:331-341. [PMID: 29178309 DOI: 10.1111/os.12351] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/10/2017] [Indexed: 12/14/2022] Open
Abstract
One of its most serious complications associated with arthroplasty is the development of infections. Although its prevalence is only between 0.5% and 3%, in some cases it can lead to death. Therefore, an important challenge in joint surgery is the prevention of infections when an arthroplasty is performed. The use of antibiotic-loaded cements could be a suitable tool due to numerous advantages. The main advantage of the use of antibiotic loading into bone cement derives directly from antibiotic release in the effect site, allowing achievement of high concentrations at the site of action, and minimal or no systemic toxicity. This route of administration was first described by Buchholz and Engelbrecht. In the case of infection treatment, this is an established method and its good results have been confirmed. However, its role in infection prevention, and, therefore, the use of these systems in clinical practice, has proved controversial because of the uncertainty about the development of possible antibiotic resistance after prolonged exposure time, their effectiveness, the cost of the systems, toxicity and loosening of mechanical properties. This review discusses all these topics, focusing on effectiveness and safety, antibiotic decisions, cement type, mixing method, release kinetics and future perspectives. The final objective is to provide the orthopaedic surgeons the right information in their clinical practice based on current evidence.
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Affiliation(s)
- Javier Martínez-Moreno
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain.,Pharmacy Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Virginia Merino
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
| | - Amparo Nácher
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
| | - José Luis Rodrigo
- Traumatology Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Mónica Climente
- Pharmacy Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Matilde Merino-Sanjuán
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
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Zheng K, Yu XC, Hu YC, Wang Z, Wu SJ, Ye ZM. How to Fill the Cavity after Curettage of Giant Cell Tumors around the Knee? A Multicenter Analysis. Chin Med J (Engl) 2018; 130:2541-2546. [PMID: 29067952 PMCID: PMC5678251 DOI: 10.4103/0366-6999.217093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Intralesional excision with curettage is the standard method of giant cell tumor (GCT) treatment, but the ideal filling material after curettage remains controversial. The purpose of this study was to compare the oncological and functional outcomes which underwent cementation or bone grafting after GCT curettage around the knee. Methods: We reported 136 cases with GCTs in distal femur or proximal tibia who accepted curettage from five clinical centers during the last 15 years. All patients were divided into two groups according to filling materials. Recurrence-free survival proportions were used to evaluate oncological outcomes while the Musculoskeletal Tumor Society (MSTS) 93 functional score was used to evaluate functional outcomes. Other parameters including surgical complication, general condition, and radiological classification had been analyzed. The valid statisitical data was analyzed using SPSS 13.0 software. Results: After GCT curettage, 86 patients (63.2%) accepted bone grafting while 50 patients (36.8%) accepted cementation. There was no statistical difference in age, gender, tumor location, radiological classification, fixation, follow-up time, and MSTS 93 functional score between cementation group and bone grafting group. The recurrence-free survival proportions showed that the recurrence rate in bone grafting group was higher than it in cementation group (P = 0.034). Surgical complication was lower in cementation group than that in bone grafting group but without statistically significant difference (P = 0.141). Conclusions: Parameters including patients’ age, gender, tumor location, and radiological classification did not affect surgeons’ treatments in cavity filling after GCT curettage. Cementation should be recommended because of easy usage, the similar postoperative knee function with bone grafting, and the better local tumor control than bone grafting.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong 250031, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong 250031, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, China
| | - Zhen Wang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Su-Jia Wu
- Department of Orthopaedics, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210000, China
| | - Zhao-Ming Ye
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
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Abstract
The principal goal of the FEBio project is to provide an advanced finite element tool for the biomechanics and biophysics communities that allows researchers to model mechanics, transport, and electrokinetic phenomena for biological systems accurately and efficiently. In addition, because FEBio is geared toward the research community, the code is designed such that new features can be added easily, thus making it an ideal tool for testing novel computational methods. Finally, because the success of a code is determined by its user base, integral goals of the FEBio project have been to offer support and outreach to our community; to provide mechanisms for dissemination of results, models, and data; and to encourage interaction between users. This review presents the history of the FEBio project, from its initial developments through its current funding period. We also present a glimpse into the future of FEBio.
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Affiliation(s)
- Steve A Maas
- Department of Bioengineering and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah 84112;
| | - Gerard A Ateshian
- Department of Mechanical Engineering and Department of Biomedical Engineering, Columbia University, New York, New York 10027
| | - Jeffrey A Weiss
- Department of Bioengineering and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah 84112; .,Department of Orthopedics, University of Utah, Salt Lake City, Utah 84112
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Caubère A, Harrosch S, Fioravanti M, Curvale G, Rochwerger A, Mattei JC. Does curettage-cement packing for treating giant cell tumors at the knee lead to osteoarthritis? Orthop Traumatol Surg Res 2017; 103:1075-1079. [PMID: 28782699 DOI: 10.1016/j.otsr.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Giant cell tumors (GCTs) make up 15 to 20% of bone-related tumors in adults. They are often found around the knee in the metaphysis and epiphysis area, contacting the joint cartilage. The aims of our study were to evaluate the presence of early knee osteoarthritis (OA) in patients with GCTs in the knee area treated by curettage-cement packing, and to evaluate whether replacing subchondral bone with acrylic cement has an effect on the functional outcomes and quality of life. MATERIAL AND METHODS This was a retrospective study of all patients operated between 2000 and 2010 by the same specialized surgical team. Functional outcomes and quality of life were evaluated in each patient using the Knee Injury and Osteoarthritis Outcome (KOOS), the Musculoskeletal Tumor Society Score (MSTS) and the Short Form-36 (SF-36). The presence of OA was evaluated in a full radiological work-up comparing the operated knee with the healthy contralateral knee. Knee OA was defined as grade 3 or grade 4 radiographic findings based on the Kellgren and Lawrence classification, and a significant difference between the operated and contralateral knee. RESULTS Nineteen patients were included in this study. The average follow-up was 120 months (range 60-180). Four patients (21%) had radiographic KL-3 and one patient (5%) had KL-4. Eight patients (42%) had recurrence of the GCT. The distance between the tumor and cartilage, and the area of the subchondral bone invaded by the tumor appeared to contribute to OA progression. DISCUSSION Resection of GCTs around the knee by curettage-cement packing did not have an effect on development of OA. In the four patients who developed knee OA, the tumor was located less than 3mm from the joint cartilage and took up more than 90% of the epiphysis. Based on these observations, there seems to be a strong correlation between the development of knee OA and the small quantity of subchondral bone left after curettage. The functional outcomes and quality of life were similar no matter the knee OA grade in patients. Replacing subchondral bone by cement had no effect on quality of life in this study. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- A Caubère
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; HIA Sainte-Anne, 26, impasse des Coquelicots, 83210 La Farlède, France.
| | - S Harrosch
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M Fioravanti
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - G Curvale
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - A Rochwerger
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J-C Mattei
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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The filling proportion of bone cement affects recollapse of vertebrae after percutaneous vertebral augmentation: A retrospective cohort study. Int J Surg 2017; 47:33-38. [PMID: 28935530 DOI: 10.1016/j.ijsu.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the relationship between filling proportion of bone cement in the vertical direction and incidence of recollapse in the augmented vertebrae after vertebral augmentation. METHODS Fifty-one patients (51 vertebrae) who had operations between January 2014 and July 2016 with a mean age of 78.10 years were included. All patients in our department of spine surgery were advised to have follow-up care every 6 months. Patients characteristics, radiographic outcomes were evaluated. RESULTS The recollapse of augmented vertebral body occurred in 10 of 51 vertebrae (20%). CONCLUSION Patients with a high proportion rate of bone cement in the middle vertical direction have a low incidence of experiencing recollapse.
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Abstract
There are many unanswered questions about giant cell tumor (GCT) treatment and not enough attention is paid to the biomechanics of the current treatment methods. Treatment methods have not changed much, and the best method remains controversial to some degree, due to the lack of adequate clinical and biomechanical investigations. Biomechanical tests, including in vitro mechanical experiments combined with finite element analysis, are very helpful in assessing the efficiency of the surgical methods employed and in determining the optimal method of surgery. Tests can be tailored to meet a patient’s needs, while limiting postoperative complications. One of the complications, following tumor surgery, is the frequency of postoperative fractures. In order to prevent postoperative fractures, defect reconstruction is recommended. The reconstruction usually consists of defect infilling with bone cement, and in the case of large defects cement augmentation is employed. Whether cement augmentation is essential and offers enough mechanical strength and what is the best fixation device for cement augmentation are areas of debate. In this article, the biomechanical studies comparing different methods of tumor surgery and cement augmentation, highlighting the areas needing more attention to advance GCT treatment, are critically reviewed. Based on our review, we recommend a biomechanical criterion for the essence of defect reconstruction, which must include patient specific factors, in addition to the tumor geometrical properties.
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Santana Artiles ME, Venetsanos DT. A new evolutionary optimization method for osteoporotic bone augmentation. Comput Methods Biomech Biomed Engin 2017; 20:691-700. [DOI: 10.1080/10255842.2017.1291805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Benevenia J, Rivero SM, Moore J, Ippolito JA, Siegerman DA, Beebe KS, Patterson FR. Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications. Clin Orthop Relat Res 2017; 475:776-783. [PMID: 26932739 PMCID: PMC5289159 DOI: 10.1007/s11999-016-4755-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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, -3.9% 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. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Joseph Benevenia
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Steven M. Rivero
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Jeffrey Moore
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Joseph A. Ippolito
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Daniel A. Siegerman
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Kathleen S. Beebe
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Francis R. Patterson
- 0000 0000 8692 8176grid.469131.8Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
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Król K, Pielichowska K. Modification of acrylic bone cements by poly(ethylene glycol) with different molecular weight. POLYM ADVAN TECHNOL 2016. [DOI: 10.1002/pat.3792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaudia Król
- AGH University of Science and Technology; Faculty of Materials Science and Ceramics; Department of Biomaterials; Al. A. Mickiewicza 30 Kraków 30-059 Poland
| | - Kinga Pielichowska
- AGH University of Science and Technology; Faculty of Materials Science and Ceramics; Department of Biomaterials; Al. A. Mickiewicza 30 Kraków 30-059 Poland
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Lv Y, Li A, Zhou F, Pan X, Liang F, Qu X, Qiu D, Yang Z. A Novel Composite PMMA-based Bone Cement with Reduced Potential for Thermal Necrosis. ACS APPLIED MATERIALS & INTERFACES 2015; 7:11280-11285. [PMID: 25966790 DOI: 10.1021/acsami.5b01447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) are now widely used to treat patients who suffer painful vertebral compression fractures. In each of these treatments, a bone cement paste is injected into the fractured vertebral body/bodies, and the cement of choice is a poly(methyl methacrylate) (PMMA) bone cement. One drawback of this cement is the very high exothermic temperature, which, it has been suggested, causes thermal necrosis of surrounding tissue. In the present work, we prepared novel composite PMMA bone cement where microcapsules containing a phase change material (paraffin) (PCMc) were mixed with the powder of the cement. A PCM absorbs generated heat and, as such, its presence in the cement may lead to reduction in thermal necrosis. We determined a number of properties of the composite cement. Compared to the values for a control cement (a commercially available PMMA cement used in VP and BKP), each composite cement was found to have significantly lower maximum exothermic temperature, increased setting time, significantly lower compressive strength, significantly lower compressive modulus, comparable biocompatibility, and significantly smaller thermal necrosis zone. Composite cement containing 20% PCMc may be suitable for use in VP and BKP and thus deserves further evaluation.
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Affiliation(s)
- Yang Lv
- †Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Ailing Li
- ‡Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Fang Zhou
- †Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoyu Pan
- §Medical College of Soochow University, Suzhou 215123, China
| | - Fuxin Liang
- ‡Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaozhong Qu
- ∥University of Chinese Academy of Sciences, Beijing 100190, China
| | - Dong Qiu
- ‡Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhenzhong Yang
- ‡Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
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Park JH, Chae IJ, Han SB, Lee DH. Arthroscopic burring of exposed cement following curettage and cavity filling cementation for chondroblastoma of the proximal tibia. Knee Surg Relat Res 2015; 27:61-4. [PMID: 25750896 PMCID: PMC4349647 DOI: 10.5792/ksrr.2015.27.1.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 12/04/2014] [Accepted: 01/20/2015] [Indexed: 12/01/2022] Open
Abstract
Chondroblastoma of the proximal tibia is difficult to treat because of its epiphyseal predilection. This condition can be treated by curettage, which results in immediate restoration of stability and a reduced recurrence rate, followed by cement filling of the bone defect. Nevertheless, contact with cement can damage articular cartilage, potentially leading to severe knee osteoarthritis. Most previous reports regarding this complication described patients with giant cell tumors of the proximal tibia. We present here a patient who underwent arthroscopic treatment for cement exposure caused by articular cartilage loss of the tibial plateau, which occurred after initial curettage and cementation for chondroblastoma of the proximal tibia. To our knowledge, this is the first report on arthroscopic treatment of this condition.
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Affiliation(s)
- Jong-Hoon Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - In-Jung Chae
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Vittore D, Vicenti G, Caizzi G, Abate A, Moretti B. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation for calcanear fracture. Injury 2014; 45 Suppl 6:S72-9. [PMID: 25457323 DOI: 10.1016/j.injury.2014.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two-thirds of hindfoot fractures involve the calcaneus. The best treatment for intraarticular fractures is still debated. The goal of treatment has been focussed for years on the anatomical reduction of the articular surface. Open reduction and internal fixation enables the surgeon to view the articular surface directly, but it is associated with a high rate of wound breakdown and infection. Therefore, length, width and angular replacement of the great tuberosity are actually the main parameters to consider when treating this type of fracture. This is a report of our experience of 20 patients treated with a minimally invasive technique of reduction using an inflatable bone tamp filled with tricalcium phosphate, with a mean follow-up of 12.25 months (range 7-26 months). Percutaneous K-wires were used to help reduction and to direct balloon inflation. Surgical goals were restoration of the mechanical stability for earlier full weight-bearing and patient mobilisation.
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Affiliation(s)
- D Vittore
- Department of Neuroscience and Organs of Sense, Orthopaedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
| | - G Caizzi
- Department of Neuroscience and Organs of Sense, Orthopaedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - A Abate
- Department of Neuroscience and Organs of Sense, Orthopaedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedic Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Zhang H, Bré L, Zhao T, Newland B, Da Costa M, Wang W. A biomimetic hyperbranched poly(amino ester)-based nanocomposite as a tunable bone adhesive for sternal closure. J Mater Chem B 2014; 2:4067-4071. [DOI: 10.1039/c4tb00155a] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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He ZZ, Xue X, Xiao J, Liu J. Anatomical model-based finite element analysis of the combined cryosurgical and hyperthermic ablation for knee bone tumor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 112:356-366. [PMID: 24070544 DOI: 10.1016/j.cmpb.2013.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 06/02/2023]
Abstract
This paper is aimed at investigating the capacity of using combined cryosurgical and hyperthermic modality for treating knee bone tumor with complex shape. An anatomical model for human knee was constructed and a three-dimensional (3D) finite element analysis was developed to determine temperature distribution of the tissues subject to single freezing (SF), single heating (SH) and alternate freezing-heating (AFH), respectively. The heat fluxes of the probes wall and the ablation volume are particularly tracked to comparatively evaluate the ablation ability of different probe configurations with varied diameter, number and active working length. As example, an effective conformal treatment strategy via one time's insertion while cyclic freezing-heating using multiple probes is designed for a predefined knee bone tumor ablation. Both SF and SH could create large enough ablation volume, while it is hard for them to perform a conformal treatment on irregular and slender knee tumor. As an alternative, AFH could form a flexible and controlled shape and volume of the ablation by changing the size and number of the probes and adjusting their insertion depth. In addition, a thermal protection method is considered to reduce cryoinjury of the health tissue.
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Affiliation(s)
- Zhi Zhu He
- Beijing Key Laboratory of Cryo-Biomedical Engineering & Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
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van der Heijden L, van de Sande MAJ, Heineken AC, Fiocco M, Nelissen RGHH, Dijkstra PDS. Mid-term outcome after curettage with polymethylmethacrylate for giant cell tumor around the knee: higher risk of radiographic osteoarthritis? J Bone Joint Surg Am 2013; 95:e159. [PMID: 24196471 DOI: 10.2106/jbjs.m.00066] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It has been suggested that, when a patient has a giant cell tumor, subchondral bone involvement close to articular cartilage and a hyperthermic reaction from polymethylmethacrylate (PMMA) are risk factors for the development of osteoarthritis. We determined the prevalence, risk factors, and clinical relevance of osteoarthritis on radiographs after curettage and application of PMMA for the treatment of giant cell tumors around the knee. METHODS This retrospective single-center study included fifty-three patients with giant cell tumor around the knee treated with curettage and PMMA between 1987 and 2007. The median age at the time of follow-up was forty-two years (range, twenty-three to seventy years). There were twenty-nine women. Radiographic evidence of osteoarthritis was defined, preoperatively and postoperatively, as Kellgren and Lawrence grade 3 or 4 (KL3-4). We studied the influence of age, sex, tumor-cartilage distance, subchondral bone involvement (≤3 mm of residual subchondral bone), subchondral bone-grafting, intra-articular fracture, multiple curettage procedures, and complications on progression to KL3-4. Functional outcomes and quality of life were assessed with the Short Form-36 (SF-36), Musculoskeletal Tumor Society (MSTS) score, and Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS After a median duration of follow-up of eighty-six months (range, sixty to 285 months), six patients (11%) had progression to KL3, two (4%) had progression to KL4, and one had preexistent KL4. No patient underwent total knee replacement. The hazard ratio for KL3-4 was 9.0 (95% confidence interval [CI] = 2.0 to 41; p = 0.004) when >70% of the subchondral bone was affected and 4.2 (95% CI = 0.84 to 21; p = 0.081) when the tumor-cartilage distance was ≤3 mm. Age, sex, subchondral bone-grafting, intra-articular fracture, multiple curettage procedures, and complications did not affect progression to KL3-4. Patients with KL3-4 reported lower scores on the KOOS symptom subscale (58 versus 82; p = 0.01), but their scores on the other KOOS subscales, the MSTS score (21 versus 24), and the SF-36 (76 versus 81) were similar to those for the patients with KL0, 1, or 2 (KL0-2). CONCLUSIONS Seventeen percent of patients with giant cell tumor around the knee had radiographic findings of osteoarthritis after treatment with curettage and PMMA. A large amount of subchondral bone involvement close to articular cartilage increased the risk for osteoarthritis. The function and quality of life of the patients with KL3-4 were comparable with those for the patients with KL0-2, suggesting that radiographic findings of osteoarthritis at the time of intermediate follow-up had a modest clinical impact. Treatment with curettage and PMMA is safe for primary and recurrent giant cell tumors, even large tumors close to the joint. LEVEL OF EVIDENCE Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van der Heijden:
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Page JM, Harmata AJ, Guelcher SA. Design and development of reactive injectable and settable polymeric biomaterials. J Biomed Mater Res A 2013; 101:3630-45. [DOI: 10.1002/jbm.a.34665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/05/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Jonathan M. Page
- Department of Chemical and Biomolecular Engineering; Vanderbilt University; Nashville Tennessee
- Center for Bone Biology; Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Andrew J. Harmata
- Department of Chemical and Biomolecular Engineering; Vanderbilt University; Nashville Tennessee
- Center for Bone Biology; Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Scott A. Guelcher
- Department of Chemical and Biomolecular Engineering; Vanderbilt University; Nashville Tennessee
- Center for Bone Biology; Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Biomedical Engineering; Vanderbilt University; Nashville Tennessee
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Sandwich reconstruction technique for subchondral giant cell tumors around the knee. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182640f1a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Puthoor DK, Puthezhath K. Management of giant cell tumor of bone: computerized tomography based selection strategy and approaching the lesion through the site of cortical break. Orthop Surg 2012; 4:76-82. [PMID: 22615151 DOI: 10.1111/j.1757-7861.2012.00172.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE A retrospective study was carried out in patients with giant cell tumor of bone to compare the functional and radiographic outcome of curettage and bone grafting using a novel CT based selection strategy to that of patients of a similar age treated with anatomic/standard curettage and bone grafting. METHODS Curettage and bone grafting after CT classification was performed in 31 patients and curettage and bone grafting without CT classification in 20. The surgical approach for curettage in the CT classified group of patients was through the site of the cortical break, irrespective of the standard approach to the particular region of bone involved. The aim of this approach was to achieve wide excision of the possibly involved soft tissue. RESULTS At similar duration of follow up (72 months) in patients with a similar mean age (33 years), Musculoskeletal Tumor Society (MSTS) scores for CT classified patients were similar to those of patients who had undergone standard curettage. However, the postoperative recurrence rate in the CT classified group was significantly less (12.9%) than in the non-CT classified group. CONCLUSION A CT based selection strategy is a valid preoperative tool for evaluation of giant cell tumor. Further, for curettage these lesions are better approached through the site of cortical break, irrespective of standard approaches, so that adequate soft tissue clearance can be achieved.
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Affiliation(s)
- Dominic K Puthoor
- Department of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Wan R, Zhang W, Xu J, Hao P, Yang Y, Shen Y, Ding X, Qiu S. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci 2012; 17:464-9. [PMID: 22526715 DOI: 10.1007/s00776-012-0228-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 03/21/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND The treatment for recurrent giant cell tumor (GCT) remains controversial. In this study, we evaluated the outcome of surgical intervention for recurrent GCT. METHOD Twenty-seven patients (14 males and 13 females) with recurrent GCT were recruited. Their primary GCTs were all treated with intralesional surgery. Among these recurrent GCTs, 9 grade III and 1 grade II tumors were treated with en bloc resection and endoprosthetic replacement, whereas 16 grade II and 1 grade III tumors were treated with intralesional curettage and PMMA bone cement filling. RESULTS The mean interval between initial surgery and first recurrence was 28.8 months (range 7-97 months). About 70 % of first recurrences affected bones around the knee, 44 % in the proximal tibia and 26 % in the distal femur. Of 27 patients, 3 women treated with intralesional procedures suffered second recurrences in the proximal tibia. No second recurrence was found in patients with en bloc resection. Two grade III re-recurrence GCTs were treated with en bloc resection, and 1 grade II was treated with an intralesional procedure. One patient with en bloc resection developed tumor metastasis in both lungs. Compared to patients with intralesional treatment, the functional score was significantly decreased in patients with en bloc resection (p < 0.01). CONCLUSION The re-recurrence risk of grade III GCTs can be significantly decreased by wide en bloc resection and endoprosthetic replacement. However, intralesional treatment is a good option for less aggressive (<grade II) recurrent GCTs because it can preserve ideal limb function and reduce surgical complications.
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Affiliation(s)
- Rong Wan
- Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Gaston CL, Bhumbra R, Watanuki M, Abudu AT, Carter SR, Jeys LM, Tillman RM, Grimer RJ. Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours in bone? ACTA ACUST UNITED AC 2011; 93:1665-9. [DOI: 10.1302/0301-620x.93b12.27663] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We retrospectively compared the outcome after the treatment of giant cell tumours of bone either with curettage alone or with adjuvant cementation. Between 1975 and 2008, 330 patients with a giant cell tumour were treated primarily by intralesional curettage, with 84 (25%) receiving adjuvant bone cement in the cavity. The local recurrence rate for curettage alone was 29.7% (73 of 246) compared with 14.3% (12 of 84) for curettage and cementation (p = 0.001). On multivariate analysis both the stage of disease and use of cement were independent significant factors associated with local recurrence. The use of cement was associated with a higher risk of the subsequent need for joint replacement. In patients without local recurrence, 18.1% (13 of 72) of those with cement needed a subsequent joint replacement compared to 2.3% (4 of 173) of those without cement (p = 0.001). In patients who developed local recurrence, 75.0% (9 of 12) of those with previous cementation required a joint replacement, compared with 45.2% (33 of 73) of those without cement (p = 0.044).
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Affiliation(s)
- C. L. Gaston
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. Bhumbra
- Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - M. Watanuki
- Tohoku University Hospital, 1-1
Seiryou-Cho, Aoba-ku, Sendai
980-8574, Japan
| | - A. T. Abudu
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - S. R. Carter
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - L. M. Jeys
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. J. Grimer
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
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High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. Sarcoma 2010; 2010. [PMID: 20706639 PMCID: PMC2913811 DOI: 10.1155/2010/586090] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/24/2010] [Indexed: 11/30/2022] Open
Abstract
Local control rates for Giant Cell Tumor of Bone (GCT) have been reported in a large number of retrospective series. However, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed. We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant. Studies were evaluated for quality and pooled data was analyzed using the fixed effects model. Data from 387 patients did not indicate improved local control with the use of surgical adjuvants. Given the available data, we conclude that surgical adjuvants are not required when meticulous tumor removal is performed.
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Gillani R, Ercan B, Qiao A, Webster TJ. Nanofunctionalized zirconia and barium sulfate particles as bone cement additives. Int J Nanomedicine 2010. [PMID: 20161983 DOI: 10.2147/ijn.s7603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Zirconia (ZrO(2)) and barium sulfate (BaSO(4)) particles were introduced into a methyl methacrylate monomer (MMA) solution with polymethyl methacrylate (PMMA) beads during polymerization to develop the following novel bone cements: bone cements with unfunctionalized ZrO(2) micron particles, bone cements with unfunctionalized ZrO(2) nanoparticles, bone cements with ZrO(2) nanoparticles functionalized with 3-(trimethoxysilyl)propyl methacrylate (TMS), bone cements with unfunctionalized BaSO(4) micron particles, bone cements with unfunctionalized BaSO(4) nanoparticles, and bone cements with BaSO(4) nanoparticles functionalized with TMS. Results demonstrated that in vitro osteoblast (bone-forming cell) densities were greater on bone cements containing BaSO(4) ceramic particles after four hours compared to control unmodified bone cements. Osteoblast densities were also greater on bone cements containing all of the ceramic particles after 24 hours compared to unmodified bone cements, particularly those bone cements containing nanofunctionalized ceramic particles. Bone cements containing ceramic particles demonstrated significantly altered mechanical properties; specifically, under tensile loading, plain bone cements and bone cements containing unfunctionalized ceramic particles exhibited brittle failure modes whereas bone cements containing nanofunctionalized ceramic particles exhibited plastic failure modes. Finally, all bone cements containing ceramic particles possessed greater radio-opacity than unmodified bone cements. In summary, the results of this study demonstrated a positive impact on the properties of traditional bone cements for orthopedic applications with the addition of unfunctionalized and TMS functionalized ceramic nanoparticles.
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Affiliation(s)
- Riaz Gillani
- Division of Engineering and Department of Orthopaedics, Brown University, 184 Hope Street, Providence, RI 02912, USA
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