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

Wangsiyuan Teng,Zenan Wang,Yong Li,Hengyuan Li,Zhaoming Ye,Shengdong Wang,Binghao Li,Peng Lin,Xiaobo Yan,Xingzhi Zhou,Yan Wu,Zhan Wang

doi:10.1007/s00264-018-3939-2

Wangsiyuan Teng, Zenan Wang + Show 10 more

Open Access

https://doi.org/10.1007/s00264-018-3939-2

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Abstract

ObjectivesThe aims of our study are (1) to explore the risk factors of mechanical failure (MF), (2) to figure out an index to evaluate this risk, and (3) to select an optimal reconstruction strategy to reduce this risk.MethodsWe retrospectively reviewed 104 patients from Dec. 2008 to Mar. 2016, undergone extensive knee curettages in our institution. Radiographs and post-operative interviews were used to classified cases of MF. Relative factors (age, tumor location, the invaded area, etc.) were also collected and analyzed by SPSS software.ResultsThick subchondral bony layer (p = 0.006) and combined grafting of the cement and bone (p = 0.006) had lower risk of mechanical failure. Mechanical failure appeared to happen in the femur (p = 0.012) more easily. The ROC curve (AUC = 0.722) reveals that less post-operative bony layer (≤ 3.3 mm) is more likely to cause mechanical failure. The Kaplan-Meier survival curve showing increased survival in those patients after a combination grafting surgery (HR, 3.799; p = 0.006).ConclusionBased on our study results, combined grafting of the cement and bone reduced the risk of mechanical failure in the knee due to the thin subchondral bone layer (SCB), especially in the femur.

Highlights

Giant cell tumor of the bone is a local aggressive benign bone tumour, and it has a potential for metastases [1]
Considering that destruction of the articular cartilage and subchondral bone due to extensive curettage led to occurrence of mechanical failure; it was crucial to figure out reliable clinical measurements to predict and reduce this risk
According to the multivariate analysis of the COX proportional hazard model (Table 2), tumour locating on the tibia (p = 0.012), thick subchondral bony layer (p = 0.006), and combined grafting of the cement and bone (p = 0.006) had lower risk of mechanical failure

Summary

Introduction

Giant cell tumor of the bone is a local aggressive benign bone tumour, and it has a potential for metastases [1]. It is commonly located in the epiphyseal regions of long bones, such as the distal femur and proximal tibia. Because of its incidence peaks in the third and fourth decade [2], preservation of the joint is of importance for these young patients [3]. To make a complete tumour removal, the structure of the joint surface may be jeopardized during. Considering that destruction of the articular cartilage and subchondral bone due to extensive curettage led to occurrence of mechanical failure; it was crucial to figure out reliable clinical measurements to predict and reduce this risk

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Conclusion