CLINICAL STUDIES ON EFFECT OF BONE CEMENT FILLING ON ARTICULAR CARTILAGE OF THE KNEE AFTER CURETTAGE OF GIANT CELL TUMOR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAOWu ^1,2 ,  YEZhaoming ¹ , LINNong ¹ , LIUMeng ¹

1. Department of Orthopedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P. R. China;
2. Department of Orthopedics, the First People's Hospital of Jiashan;

Corresponding author：

YEZhaoming, Email: yezhaominghz@163.com

Keywords：

Knee joint; Giant cell tumor; Articular cartilage; Bone cement; Complication

DOI：

10.7507/1002-1892.20140316

Video：

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Objective To evaluate the effect of bone cement filling on articular cartilage injury after curettage of giant cell tumor around the knee. Methods Fifty-three patients with giant cell tumor who accorded with the inclusion criteria were treated between January 2000 and December 2011, and the cl inical data were retrospectively analyzed. There were 30 males and 23 females, aged 16-69 years (mean, 34.2 years). The lesion located at the distal femur in 28 cases and at the proximal tibia in 25 cases. According to Campanacci grade, there were 6 patients at grade I, 38 at grade Ⅱ, and 9 at grade Ⅲ. Of 53 patients, 42 underwent curettage followed by bone cement fill ing, and 11 received curettage followed by bone grafts in the subchondral bony area and bone cement fill ing. Two groups were divided according to whether secondary osteoarthritis occurred or not during postoperative follow-up. The gender, age, lesion site, the subchondral residual bone thickness, tumor cross section, preoperative Campanacci grade, subchondral bone graft, and Enneking function score were compared between 2 groups, and multivariate logistic regression analysis was done. Results All incisions healed by first intention. The average follow-up time was 65 months (range, 23-158 months). Of 53 cases, 37 (69.8%) had no osteoarthritis, and 16 (30.2%) had secondary osteoarthritis. Three cases (5.7%) recurred during the follow-up period. Univariate logistic regression analysis showed no significant difference in gender, age, lesion site, and Campanacci grade between 2 groups (P>0.1); difference was significant in the subchondral residual bone thickness, tumor cross section, Enneking function score, and subchondral bone graft (P<0.1). The multivariate logistic regression analysis showed that the decreased subchondral residual bone thickness, the increased tumor cross section, and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis (P<0.05). Conclusion Curettage of giant cell tumor around the knee followed by bone cement filling can increase the damage of cartilage, and subchondral bone graft can delay or reduce cartilage injury.

Citation： CAOWu, YEZhaoming, LINNong, LIUMeng. CLINICAL STUDIES ON EFFECT OF BONE CEMENT FILLING ON ARTICULAR CARTILAGE OF THE KNEE AFTER CURETTAGE OF GIANT CELL TUMOR. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1459-1463. doi: 10.7507/1002-1892.20140316 Copy

1.	Niu X, Zhang Q, Hao L, et al. Giant cell tumor of the extremity:retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg (Am), 2012, 94(5):461-467.
2.	Mendenhall WM, Zlotecki RA, Scarborough MT, et al. Giant cell tumor of bone. Am J Clin Oncol, 2006, 29(1):96-99.
3.	Asavamongkolkul A, Eamsobhana P, Waikakul S, et al. The outcomes of treatment of giant cell tumor of bone around the knee. J Med Assoc Thai, 2012, 95 Suppl 9:S122-S128.
4.	Errani C, Ruggieri P, Asenzio MA, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev, 2010, 36(1):1-7.
5.	Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Cl in Orthop Relat Res, 2011, 469(2):591-599.
6.	Kivioja AH, Blomqvist C, Hietaniemi K, et al. Cement is recommended in intralesional surgery of giant cell tumors:a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop, 2008, 79(1):86-93.
7.	Becker WT, Dohle J, Bernd L, et al. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg (Am), 2008, 90(5):1060-1067.
8.	Radev BR, Kase JA, Askew MJ, et al. Potential for thermal damage to articular cartilage by PMMA reconstruction of a bone cavity following tumor excision:A finite element study. J Biomech, 2009, 42(8):1120-1126.
9.	Gortzak Y, Kandel R, Deheshi B, et al. The efficacy of chemical adjuvants on giant-cell tumour of bone. An in vitro study. J Bone Joint Surg (Br), 2010, 92(10):1475-1479.
10.	Chen TH, Su YP, Chen WM. Giant cell tumors of the knee:subchondral bone integrity affects the outcome. Int Orthop, 2005, 29(1):30-34.
11.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286):241-246.
12.	Aboulafia AJ, Rosenbaum DH, Sicard-Rosenbaum L, et al. Treatment of large subchondral tumors of the knee with cryosurgery and composite reconstruction. Clin Orthop Relat Res, 1994, (307):189-199.
13.	van Saase JL, van Romunde LK, Cats A, et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis, 1989, 48(4):271-280.
14.	Campanacci M, Capanna R, Fabbri N, et al. Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov, 1990, 75(1 Suppl):212-213.
15.	Abdelrahman M, Bassiony AA, Shalaby H, et al. Cryosurgery and impaction subchondral bone graft for the treatment of giant cell tumor around the knee. HSS J, 2009, 5(2):123-128.
16.	Canale ST, Besty J. 坎贝尔骨科手术学. 11版. 卢世璧, 译. 北京:人民军医出版社:710-716.
17.	von Steyern FV, Kristiansson I, Jonsson K, et al. Giant-cell tumour of the knee:the condition of the cartilage after treatment by curettage and cementing. J Bone Joint Surg (Br), 2007, 89(3):361-365.
18.	Fraquet N, Faizon G, Rosset P, et al. Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res, 2009, 95(6):402-406.
19.	Frassica FJ, Gorski JP, Pritchard DJ, et al. A comparative analysis of subchondral replacement with polymethylmethacrylate or autogenous bone grafts in dogs. Clin Orthop Relat Res, 1993, (293):378-390.
20.	Wada T, Kaya M, Nagoya S, et al. Complications associated with bone cementing for the treatment of giant cell tumors of bone. J Orthop Sci, 2002, 7(2):194-198.
21.	Tejwani SG, Hame SL, Eckardt JJ. Subchondral giant-cell tumor of the proximal tibia:arthroscopic treatment for accelerated articular cartilage and meniscal degeneration in two patients. Arthroscopy, 2004, 20(6):644-649.
22.	Gaston CL, Bhumbra R, Watanuki M, et al. Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours in bone? J Bone Joint Surg (Br), 2011, 93(12):1665-1669.
23.	Suzuki Y, Nishida Y, Yamada Y, et al. Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone. Knee, 2007, 14(5):369-374.

1. Niu X, Zhang Q, Hao L, et al. Giant cell tumor of the extremity:retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg (Am), 2012, 94(5):461-467.
2. Mendenhall WM, Zlotecki RA, Scarborough MT, et al. Giant cell tumor of bone. Am J Clin Oncol, 2006, 29(1):96-99.
3. Asavamongkolkul A, Eamsobhana P, Waikakul S, et al. The outcomes of treatment of giant cell tumor of bone around the knee. J Med Assoc Thai, 2012, 95 Suppl 9:S122-S128.
4. Errani C, Ruggieri P, Asenzio MA, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev, 2010, 36(1):1-7.
5. Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Cl in Orthop Relat Res, 2011, 469(2):591-599.
6. Kivioja AH, Blomqvist C, Hietaniemi K, et al. Cement is recommended in intralesional surgery of giant cell tumors:a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop, 2008, 79(1):86-93.
7. Becker WT, Dohle J, Bernd L, et al. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg (Am), 2008, 90(5):1060-1067.
8. Radev BR, Kase JA, Askew MJ, et al. Potential for thermal damage to articular cartilage by PMMA reconstruction of a bone cavity following tumor excision:A finite element study. J Biomech, 2009, 42(8):1120-1126.
9. Gortzak Y, Kandel R, Deheshi B, et al. The efficacy of chemical adjuvants on giant-cell tumour of bone. An in vitro study. J Bone Joint Surg (Br), 2010, 92(10):1475-1479.
10. Chen TH, Su YP, Chen WM. Giant cell tumors of the knee:subchondral bone integrity affects the outcome. Int Orthop, 2005, 29(1):30-34.
11. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286):241-246.
12. Aboulafia AJ, Rosenbaum DH, Sicard-Rosenbaum L, et al. Treatment of large subchondral tumors of the knee with cryosurgery and composite reconstruction. Clin Orthop Relat Res, 1994, (307):189-199.
13. van Saase JL, van Romunde LK, Cats A, et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis, 1989, 48(4):271-280.
14. Campanacci M, Capanna R, Fabbri N, et al. Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov, 1990, 75(1 Suppl):212-213.
15. Abdelrahman M, Bassiony AA, Shalaby H, et al. Cryosurgery and impaction subchondral bone graft for the treatment of giant cell tumor around the knee. HSS J, 2009, 5(2):123-128.
16. Canale ST, Besty J. 坎贝尔骨科手术学. 11版. 卢世璧, 译. 北京:人民军医出版社:710-716.
17. von Steyern FV, Kristiansson I, Jonsson K, et al. Giant-cell tumour of the knee:the condition of the cartilage after treatment by curettage and cementing. J Bone Joint Surg (Br), 2007, 89(3):361-365.
18. Fraquet N, Faizon G, Rosset P, et al. Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res, 2009, 95(6):402-406.
19. Frassica FJ, Gorski JP, Pritchard DJ, et al. A comparative analysis of subchondral replacement with polymethylmethacrylate or autogenous bone grafts in dogs. Clin Orthop Relat Res, 1993, (293):378-390.
20. Wada T, Kaya M, Nagoya S, et al. Complications associated with bone cementing for the treatment of giant cell tumors of bone. J Orthop Sci, 2002, 7(2):194-198.
21. Tejwani SG, Hame SL, Eckardt JJ. Subchondral giant-cell tumor of the proximal tibia:arthroscopic treatment for accelerated articular cartilage and meniscal degeneration in two patients. Arthroscopy, 2004, 20(6):644-649.
22. Gaston CL, Bhumbra R, Watanuki M, et al. Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours in bone? J Bone Joint Surg (Br), 2011, 93(12):1665-1669.
23. Suzuki Y, Nishida Y, Yamada Y, et al. Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone. Knee, 2007, 14(5):369-374.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL STUDIES ON EFFECT OF BONE CEMENT FILLING ON ARTICULAR CARTILAGE OF THE KNEE AFTER CURETTAGE OF GIANT CELL TUMOR

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