Risk factors of fracture following curettage for bone giant cell tumors of the extremities.
Bone grafting
Cement
Curettage
Denosumab
Fracture
Giant cell tumor of bone
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
19 May 2022
19 May 2022
Historique:
received:
18
10
2021
accepted:
17
05
2022
entrez:
19
5
2022
pubmed:
20
5
2022
medline:
24
5
2022
Statut:
epublish
Résumé
Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2-14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities. This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16). Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8-8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3-118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8-96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2-97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1-99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7-99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7-97.3; p = 0.003). For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.
Sections du résumé
BACKGROUND
BACKGROUND
Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2-14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities.
METHODS
METHODS
This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16).
RESULTS
RESULTS
Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8-8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3-118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8-96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2-97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1-99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7-99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7-97.3; p = 0.003).
CONCLUSIONS
CONCLUSIONS
For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.
Identifiants
pubmed: 35590280
doi: 10.1186/s12891-022-05447-x
pii: 10.1186/s12891-022-05447-x
pmc: PMC9118605
doi:
Substances chimiques
Bone Cements
0
Polymethyl Methacrylate
9011-14-7
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
477Informations de copyright
© 2022. The Author(s).
Références
Clin Orthop Relat Res. 2004 Mar;(420):251-6
pubmed: 15057105
Clin Orthop Relat Res. 2020 May;478(5):1076-1085
pubmed: 31794487
J Bone Joint Surg Am. 2018 Mar 21;100(6):496-504
pubmed: 29557866
Clin Orthop Relat Res. 2007 Jun;459:96-104
pubmed: 17417093
J Pediatr Orthop. 2014 Jan;34(1):92-100
pubmed: 23812148
Indian J Orthop. 2007 Apr;41(2):109-14
pubmed: 21139761
Orthopedics. 2020 Sep 1;43(5):284-291
pubmed: 32745221
Am J Orthop (Belle Mead NJ). 2011 Jun;40(6):E105-9
pubmed: 21869943
J Orthop Res. 1989;7(4):579-84
pubmed: 2544712
J Biomed Mater Res. 2002 Mar 5;59(3):490-8
pubmed: 11774307
Comput Biol Med. 2019 Sep;112:103360
pubmed: 31330318
Clin Orthop Relat Res. 1993 Aug;(293):378-90
pubmed: 8339507
J Bone Joint Surg Am. 2014 Mar 5;96(5):e35
pubmed: 24599207
Bone Joint J. 2018 Dec;100-B(12):1626-1632
pubmed: 30499317
Eur J Orthop Surg Traumatol. 2017 Aug;27(6):813-819
pubmed: 28589498
Clin Orthop Relat Res. 1985 Jan-Feb;(192):149-58
pubmed: 3967417
J Bone Joint Surg Am. 2013 Nov 6;95(21):e159
pubmed: 24196471
Orthopedics. 2014 Mar;37(3):158-62
pubmed: 24762144
J Surg Oncol. 2019 Jun;119(7):864-872
pubmed: 30734307
Bone Joint J. 2014 Jan;96-B(1):127-31
pubmed: 24395323
Clin Orthop Relat Res. 2013 Mar;471(3):820-9
pubmed: 22926445
Clin Orthop Relat Res. 2017 Mar;475(3):776-783
pubmed: 26932739
Sci Rep. 2020 Dec 7;10(1):21319
pubmed: 33288803
J Surg Oncol. 2021 Apr;123(5):1299-1303
pubmed: 33524202
Orthopedics. 2009 Aug;32(8):
pubmed: 19708631
Arch Orthop Trauma Surg (1978). 1982;100(1):3-10
pubmed: 7125872
Int Orthop. 2006 Apr;30(2):135-8
pubmed: 16474936
Int Orthop. 2018 Jan;42(1):203-213
pubmed: 28988294
Eur J Orthop Surg Traumatol. 2020 Jan;30(1):3-9
pubmed: 31520122
J Bone Joint Surg Am. 1987 Jan;69(1):106-14
pubmed: 3805057
Clin Orthop Relat Res. 2007 May;458:159-67
pubmed: 17290156
Lancet Oncol. 2013 Aug;14(9):901-8
pubmed: 23867211
J Orthop Traumatol. 2016 Sep;17(3):249-54
pubmed: 26883439
J Bone Joint Surg Am. 1994 Dec;76(12):1827-33
pubmed: 7989388
Acta Orthop. 2009 Feb;80(1):4-8
pubmed: 19234881
J Orthop Res. 2002 May;20(3):464-72
pubmed: 12038619
Oncol Lett. 2013 May;5(5):1595-1598
pubmed: 23760940