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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(01): 141-148
DOI: 10.1055/s-0042-1742603
Artigo Original
Oncologia

Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study

Article in several languages: português | English

Authors

  • Badaruddin Sahito 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão

  • Sheikh Muhammad Ebad Ali 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão

  • Bushra Majid 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão

  • Muhammad Soughat Katto 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão

  • Asif Jatoi 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão

  • Syed Jahanzeb 

    1   Department of Orthopedics, Dr Ruth KM Pfau Civil Hospital Karachi, Paquistão
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Abstract

Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes.

Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively.

Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p = 0.178), in the knee society score (78.67 versus 81.46; p = 0.33), recurrence (0 versus 0%; p = 1), and complications (25 versus 7.69%; p = 0.21).

Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Keywords

giant cell tumors - bone grafting - bone cementing - extended curettage - knee/surgery

Ethics Approval

The study was approved by Human Subject Review Board.


Contributions of the Authors

Sahito B. and Ali S. M. E. conceived the study and performed data collection and critical revision. Majid B., Katto S. A., Jatoi A. and Jahanzeb S. performed designing, data interpretation and drafting. All the authors approved the final draft and stand accountable for the validity of the data.


Financial Support

There was no financial support from any public, commercial, or non-profit sources.


Work developed at Department of Orthopaedics Dr Ruth KM Pfau, Civil Hospital Karachi, Pakistan.




Publication History

Received: 12 August 2021

Accepted: 22 November 2021

Article published online:
25 April 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Muheremu A, Niu X. Pulmonary metastasis of giant cell tumor of bones. World J Surg Oncol 2014; 12: 261
    Search in Google Scholar
  • 2 Puri A, Agarwal M. Treatment of giant cell tumor of bone: Current concepts. Indian J Orthop 2007; 41 (02) 101-108
    Search in Google Scholar
  • 3 Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987; 69 (01) 106-114
    Search in Google Scholar
  • 4 Sahito B, Ali SME, Kumar D, Kumar J, Hussain N, Lakho T. Role of denosumab before resection and reconstruction in giant cell tumors of bone: a single-centered retrospective cohort study [published online ahead of print, 2021 May 29]. Eur J Orthop Surg Traumatol 2021;10.1007/s00590-021-03012-1
  • 5 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016; 4 (01) 2-9
    Search in Google Scholar
  • 6 Hasan O, Ali M, Mustafa M, Ali A, Umer M. Treatment and recurrence of giant cell tumors of bone - A retrospective cohort from a developing country. Ann Med Surg (Lond) 2019; 48: 29-34
    Search in Google Scholar
  • 7 Bernardes M, Santos F, Frias M, Sá D, Duarte G, Lemos R. Giant Cell Tumor with Fracture of the Proximal Radius - Reconstructive Surgery with Radius Allograft. J Orthop Case Rep 2020; 10 (03) 32-35
    Search in Google Scholar
  • 8 Errani C, Tsukamoto S, Leone G. et al. Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites. Eur J Orthop Surg Traumatol 2017; 27 (06) 813-819
    Search in Google Scholar
  • 9 Saibaba B, Chouhan DK, Kumar V, Dhillon MS, Rajoli SR. Curettage and reconstruction by the sandwich technique for giant cell tumours around the knee. J Orthop Surg (Hong Kong) 2014; 22 (03) 351-355
    Search in Google Scholar
  • 10 Datta NK, Das KP, Mia MM, Aish PK. Limb Salvage by Resection Arthrodesis with the use of Osteoarticular Allograft in the Treatment of Aggressive Giant Cell Tumour around the Knee. Mymensingh Med J 2020; 29 (02) 317-324
    Search in Google Scholar
  • 11 Jung SH. Stratified Fisher's exact test and its sample size calculation. Biom J 2014; 56 (01) 129-140
    Search in Google Scholar
  • 12 Greenberg DD, Lee FY. Bisphosphonate-loaded Bone Cement as a Local Adjuvant Therapy for Giant Cell Tumor of Bone: A 1 to 12-Year Follow-up Study. Am J Clin Oncol 2019; 42 (03) 231-237
    Search in Google Scholar
  • 13 Yu X, Xu M, Xu S, Su Q. Clinical outcomes of giant cell tumor of bone treated with bone cement filling and internal fixation, and oral bisphosphonates. Oncol Lett 2013; 5 (02) 447-451
    Search in Google Scholar
  • 14 Takeuchi A, Suwanpramote P, Yamamoto N. et al. Mid- to long-term clinical outcome of giant cell tumor of bone treated with calcium phosphate cement following thorough curettage and phenolization. J Surg Oncol 2018; 117 (06) 1232-1238
    Search in Google Scholar
  • 15 Chen KH, Wu PK, Chen CF, Chen WM. Zoledronic acid-loaded bone cement as a local adjuvant therapy for giant cell tumor of the sacrum after intralesional curettage. Eur Spine J 2015; 24 (10) 2182-2188
    Search in Google Scholar
  • 16 Kundu ZS, Gogna P, Singla R, Sangwan SS, Kamboj P, Goyal S. Joint salvage using sandwich technique for giant cell tumors around knee. J Knee Surg 2015; 28 (02) 157-164
    Search in Google Scholar
  • 17 Wu M, Yao S, Xie Y. et al. 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 (45) e13154
    Search in Google Scholar
  • 18 Song Y, Li CF, Shi XT, Cheng YQ, Suo HQ, Liu JG. [Expanded curettage and bone cement filling combined with internal fixation for the treatment of Campanacci III giant cell tumour of knee joint]. Zhongguo Gu Shang 2019; 32 (04) 372-376
    Search in Google Scholar
  • 19 Gupta SP, Garg G. Curettage with cement augmentation of large bone defects in giant cell tumors with pathological fractures in lower-extremity long bones. J Orthop Traumatol 2016; 17 (03) 239-247
    Search in Google Scholar
  • 20 Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am 2012; 23 (03) 675-687
    Search in Google Scholar
  • 21 Sas A, Van Camp D, Lauwers B, Sermon A, van Lenthe GH. Cement augmentation of metastatic lesions in the proximal femur can improve bone strength. J Mech Behav Biomed Mater 2020; 104: 103648
    Search in Google Scholar
  • 22 Martimbianco AL, Calabrese FR, Iha LA, Petrilli M, Lira Neto O, Carneiro Filho M. Reliability of the “American Knee Society Score” (AKSS). Acta Ortop Bras 2012; 20 (01) 34-38
    Search in Google Scholar
  • 23 Vaishya R, Pokhrel A, Agarwal AK, Vijay V. Current status of bone cementing and bone grafting for giant cell tumour of bone: a systemic review. Ann R Coll Surg Engl 2019; 101 (02) 79-85
    Search in Google Scholar
  • 24 Pietschmann MF, Dietz RA, Utzschneider S, Baur-Melnyk A, Jansson V, Dürr HR. The influence of adjuvants on local recurrence rate in giant cell tumour of the bone. Acta Chir Belg 2010; 110 (06) 584-589
    Search in Google Scholar
  • 25 Dürr HR, Maier M, Jansson V, Baur A, Refior HJ. Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol 1999; 25 (06) 610-618
    Search in Google Scholar
  • 26 Abuhejleh H, Wunder JS, Ferguson PC. et al. Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol 2020; 30 (01) 11-17
    Search in Google Scholar
  • 27 Pazionis TJ, Alradwan H, Deheshi BM, Turcotte R, Farrokhyar F, Ghert M. A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius. Open Orthop J 2013; 7: 103-108
    Search in Google Scholar
  • 28 Farfalli GL, Slullitel PA, Muscolo DL, Ayerza MA, Aponte-Tinao LA. What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty. Clin Orthop Relat Res 2017; 475 (03) 760-766
    Search in Google Scholar
  • 29 Araki Y, Yamamoto N, Hayashi K. et al. 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 (03) e19.00068
    Search in Google Scholar
  • 30 Xu HR, Niu XH, Zhang Q, Hao L, Ding Y, Li Y. Subchondral bone grafting reduces degenerative change of knee joint in patients of giant cell tumor of bone. Chin Med J (Engl) 2013; 126 (16) 3053-3056
    Search in Google Scholar