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Risk factors of fracture following curettage for bone giant cell tumors of the extremities
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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118605/ https://www.ncbi.nlm.nih.gov/pubmed/35590280 http://dx.doi.org/10.1186/s12891-022-05447-x |
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author | Tsukamoto, Shinji Mavrogenis, Andreas F. Akahane, Manabu Honoki, Kanya Kido, Akira Tanaka, Yasuhito Donati, Davide Maria Errani, Costantino |
author_facet | Tsukamoto, Shinji Mavrogenis, Andreas F. Akahane, Manabu Honoki, Kanya Kido, Akira Tanaka, Yasuhito Donati, Davide Maria Errani, Costantino |
author_sort | Tsukamoto, Shinji |
collection | PubMed |
description | 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: 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: 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: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05447-x. |
format | Online Article Text |
id | pubmed-9118605 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-91186052022-05-20 Risk factors of fracture following curettage for bone giant cell tumors of the extremities Tsukamoto, Shinji Mavrogenis, Andreas F. Akahane, Manabu Honoki, Kanya Kido, Akira Tanaka, Yasuhito Donati, Davide Maria Errani, Costantino BMC Musculoskelet Disord Research 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: 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: 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: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05447-x. BioMed Central 2022-05-19 /pmc/articles/PMC9118605/ /pubmed/35590280 http://dx.doi.org/10.1186/s12891-022-05447-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Tsukamoto, Shinji Mavrogenis, Andreas F. Akahane, Manabu Honoki, Kanya Kido, Akira Tanaka, Yasuhito Donati, Davide Maria Errani, Costantino Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title | Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title_full | Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title_fullStr | Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title_full_unstemmed | Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title_short | Risk factors of fracture following curettage for bone giant cell tumors of the extremities |
title_sort | risk factors of fracture following curettage for bone giant cell tumors of the extremities |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118605/ https://www.ncbi.nlm.nih.gov/pubmed/35590280 http://dx.doi.org/10.1186/s12891-022-05447-x |
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