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Atherley O'Meally A, Cosentino M, Aiba H, Aso A, Solou K, Rizzi G, Bordini B, Donati DM, Errani C. Similar complications, implant survival, and function following modular prosthesis and allograft-prosthesis composite reconstructions of the proximal femur for primary bone tumors: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1581-1595. [PMID: 38363346 DOI: 10.1007/s00590-024-03846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE There is a lack of consensus regarding the best type of reconstruction of the proximal femur following bone tumor resection. The objective of this study was to analyze the complication risks, implant survival, and functional outcomes following modular prosthesis (MP) and allograft-prosthesis composite (APC) reconstruction of the proximal femur after primary bone tumor resections. METHODS We performed a search in the PubMed and Scopus libraries, obtaining 1 843 studies. We included studies reporting functional outcomes, complications, and implant survival of proximal femur reconstruction with MP or APC following primary bone tumor resection with a 2-year minimum follow-up. We excluded studies analyzing metastatic patients or studies with pooled data in which it was impossible to separate the data of patients with primary bone tumors from those with bone metastases. RESULTS We analyzed 18 studies (483 patients) reporting on 234 (48%) patients with MP reconstruction and 249 (52%) patients with APC reconstruction. The risk of complications was similar in patients with MP reconstruction (29%; 95% CI [0.11; 0.47]) and APC reconstruction (36%; 95% CI [0.24; 0.47]) (p = 0.48). Implant survival following MP reconstruction ranged from 81 to 86% at 5 years, 75 to 86% at 10 years, and 82% at 15 years. Implant survival following APC reconstruction ranged from 86 to 100% at 5 years and 86% at 10 years, and 86% at 15 years. Functional outcomes following MP reconstruction and APC reconstruction ranged from 24.0 to 28.3 and from 21.9 to 27.8, respectively. CONCLUSION Patients with primary bone tumor of the proximal femur who underwent MP or APC reconstruction seem to have similar complication risks, implant survival, and functional outcomes.
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Affiliation(s)
- Ahmed Atherley O'Meally
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedic Surgery, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Hisaki Aiba
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Ayano Aso
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Konstantina Solou
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Patras, Patras, Greece
| | - Giovanni Rizzi
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Kumar A, Keshav K, Singh S, Singh A. Postoperative Fracture Risk in Giant Cell Tumor: A Case Report and Review of Literature. Cureus 2023; 15:e46192. [PMID: 37905245 PMCID: PMC10613347 DOI: 10.7759/cureus.46192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Giant cell tumor (GCT) of the proximal femur poses various challenges in its management and recurrence. We present a rare case of GCT of proximal femur in which recurrence and coxa vara deformity were encountered after index surgery. Management of the recurrence was done with intramedullary fixation with extended curettage and bone grafting. Different aspects of management such as the role of defect size, adjuvants, bone cement/bone graft, implants, and bisphosphonates have been highlighted in this article.
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Affiliation(s)
- Amit Kumar
- Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Kumar Keshav
- Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Siddhartha Singh
- Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Amarendra Singh
- Trauma and Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
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Elbardesy H, Sheridan GA, Guerin S. Giant Cell Tumor of the Femoral Head: A Case Report and Review of the Literature. J Orthop Case Rep 2021; 11:48-51. [PMID: 34557439 PMCID: PMC8422002 DOI: 10.13107/jocr.2021.v11.i05.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Giant cell tumors (GCTs) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphysis of long bones. GCT of the femoral head is rarely encountered. Case Report We report a rare case of GCT of the femoral head in a 20-year-old female. The patient presented with pathological fracture. The patient underwent total hip arthroplasty (THA). The aim of this paper is to present a case study with pathological fracture of the femoral head and to report the results of a literature review. Conclusion The treatment of choice for GCT of the proximal femur is a hip arthroplasty with either a standard THA for small confined tumors or endoprosthesis insertion for more extensive tumors. Joint preserving procedures have a high revision rate (47.06%). Denosumab has been tried as a neoadjuvant treatment with some success in certain cases.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork, Ireland
| | - G A Sheridan
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork, Ireland
| | - S Guerin
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork, Ireland
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Kumar A, Sinha S, Haider Y, Jameel J, Kumar S. Role of Zoledronic Acid Supplementation in Reducing Post-Surgical Recurrence of Giant Cell Tumor of Bone: A Meta-Analysis of Comparative Studies. Cureus 2021; 13:e16742. [PMID: 34471584 PMCID: PMC8403108 DOI: 10.7759/cureus.16742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 01/17/2023] Open
Abstract
Zoledronic acid is a bisphosphonate that has recently gained interest in adjuvant therapy for giant cell tumor of bone (GCTB). It has an apoptotic effect on osteoclasts that are precursors of GCTB. However, the evidence suggesting the role of zoledronic acid in preventing GCTB recurrence is mixed, and therefore, a consensus is yet to be established. The purpose of the current meta-analysis was to analyze the impact of zoledronic acid supplementation on tumor recurrence in surgical treated GCTB. A systematic search was conducted on PubMed, Embase, and Web of Science databases to identify studies that analyzed the impact of local or systemic zoledronic acid supplementation on clinical outcomes in surgically treated GCTB. The data from the comparative studies were pooled and analyzed to investigate the association of zoledronic acid supplementation with tumor recurrence. Additionally, other factors such as age, gender, soft tissue extension, polymethyl methacrylate (PMMA) cement application, recurrent presentation, and extended curettage were also investigated for any association with tumor recurrence. Of the 271 results, 13 unique studies reported the clinical outcomes in GCTB. Seven studies compared the outcomes of zoledronic acid supplementation with control groups. Six studies presented the tumor recurrence-related data among the comparison groups. The zoledronic acid supplementation was associated with significantly lower tumor recurrence rates (p = 0.007). Additionally, a significant association of soft tissue extension and non-usage of PMMA cement with tumor recurrence were observed. The current meta-analysis suggests that zoledronic acid supplementation reduces tumor recurrence rates in surgically treated GCTB. We, therefore, recommend the use of zoledronic acid following aggressive extended curettage of the tumor. Further, well-planned randomized controlled trials will help strengthen this evidence.
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Affiliation(s)
- Arvind Kumar
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Siddhartha Sinha
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Yawar Haider
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Javed Jameel
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Sandeep Kumar
- Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
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Abstract
PURPOSE OF REVIEW To highlight the new developments in the management of advanced giant cell tumor of bone, a rare locally aggressive benign tumor, which was traditionally managed with surgery alone by either curettage and local adjuvant therapy, wide resection, or marginal excision. Here, we review the current role of systemic therapy for management of locally advanced or metastatic giant cell tumor of bone (GCTB). RECENT FINDINGS The elucidation of the pathophysiology of giant cell tumor of bone, especially with regards to the role of nuclear factor kappa B ligand (RANKL), has led to the Food and Drug Administration (FDA) approval of denosumab in the management of locally advanced or metastatic GCTB. For advanced giant cell tumor where surgical resection alone can cause severe morbidity, the paradigm has shifted from local treatment alone to multidisciplinary management with the consideration of use of denosumab.
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Affiliation(s)
- Atrayee Basu Mallick
- Department of Medical Oncology, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 700, Philadelphia, PA, 19107, USA.
| | - Sant P Chawla
- Sarcoma Oncology Center, 2811 Wilshire Blvd, Santa Monica, CA, 90403, USA
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Wilson PJ, Steadman P, Beckman EM, Connick MJ, Carty CP, Tweedy SM. Fitness, Function, and Exercise Training Responses after Limb Salvage With a Lower Limb Megaprosthesis: A Systematic Review. PM R 2019; 11:533-547. [PMID: 30844129 DOI: 10.1002/pmrj.12045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the fitness, function, and exercise training responses of patients following reconstruction of the lower limb with a total femoral (TF), proximal femoral (PF), distal femoral (DF), or proximal tibial (PT) megaprosthesis. TYPE: Systematic review. LITERATURE SURVEY Five research databases were searched systematically for original studies published in English from 2006 to 2017 that reported fitness, functioning, or exercise training responses for one or more of the four types of lower limb megaprosthesis listed above. METHODOLOGY Methodologic quality was assessed using a 22-item modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. SYNTHESIS Of the 5342 articles retrieved, 28 met the inclusion criteria. Thirteen studies reported fitness outcomes, primarily in PT, with none in TF. Impaired knee extensor strength of the affected limb was reported following limb salvage with PF, DF, and PT megaprosthetics. Impaired flexibility was reported following limb salvage with DF and PT megaprosthetics. Functional outcomes were described in all studies and were most commonly reported using the Musculoskeletal Tumor Society (MSTS) system score. Results indicated no clear difference in functional outcomes between megaprosthesis locations. No studies evaluated exercise training responses. CONCLUSIONS This review identified impairments of lower limb strength and flexibility following limb salvage with a lower limb megaprosthesis. Similarity in functional outcomes for all four reported megaprosthetic locations may indicate a lack of sensitivity in outcome measures, including the absence of items assessing higher-level functioning. Exercise interventions that aim to improve fitness and function in this population have not been evaluated but are required given increasing 5-year survival rates. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Paula J Wilson
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Peter Steadman
- The University of Queensland, School of Medicine, Brisbane, Australia
| | - Emma M Beckman
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Mark J Connick
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Christopher P Carty
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Sean M Tweedy
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Janssen SJ, Langerhuizen DWG, Schwab JH, Bramer JAM. Outcome after reconstruction of proximal femoral tumors: A systematic review. J Surg Oncol 2018; 119:120-129. [DOI: 10.1002/jso.25297] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/25/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Stein J. Janssen
- Department of Orthopaedic SurgeryAmphia HospitalBreda The Netherlands
| | - David W. G. Langerhuizen
- Department of Orthopaedic SurgeryAcademic Medical Center, University of AmsterdamAmsterdam The Netherlands
| | - Joseph H. Schwab
- Department of Orthopaedic SurgeryOrthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical SchoolBoston Massachusetts
| | - Jos A. M. Bramer
- Department of Orthopaedic SurgeryAcademic Medical Center, University of AmsterdamAmsterdam The Netherlands
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Gautam D, Malhotra R. Megaprosthesis versus Allograft Prosthesis Composite for massive skeletal defects. J Clin Orthop Trauma 2018; 9:63-80. [PMID: 29628687 PMCID: PMC5884048 DOI: 10.1016/j.jcot.2017.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 02/09/2023] Open
Abstract
Massive skeletal defects are encountered in the setting of tumors necessitating excision, failed total hip arthroplasty with periprosthetic bone loss, periprosthetic fracture, complex trauma, multiple failed osteosynthesis and infection. Reconstruction of the segmental defects poses a tremendous challenge to the orthopaedic surgeons. The goal of osseous reconstruction of these defects is to restore the bone length and function. Currently the most commonly employed methods for reconstruction are either a megaprosthesis or an Allograft Prosthesis Composite (APC). Megaprosthesis, initially created for the treatment in neoplastic pathologies are being used for the non-neoplastic pathologies as well. The longevity of these implants is an issue as majority of the patients receiving them are the survivors of oncologic issue or elderly population, both in which the life expectancy is limited. However, the early complications like instability, infection, prosthetic breakage and fixation failure have been extensively reported in several literatures. Moreover, the megaprostheses are non-biological options preventing secure fixation of the soft tissue around the implant. The Allograft Prosthesis Composites were introduced to overcome the complications of megaprosthesis. APC is made of a revision-type prosthesis cemented into the skeletal allograft to which the remaining soft tissue sleeve can be biologically fixed. APCs are preferred in young and low risk patients. Though the incidence of instability is relatively low with the composites as compared to the megaprosthesis, apart from infection, the newer complications pertaining to APCs are inevitable that includes non-union, allograft resorption, periprosthetic fracture and potential risk of disease transmission. The current review aims to give an overview on the treatment outcomes, complications and survival of both the megaprostheses and APCs at different anatomic sites in both the upper and lower limbs.
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Affiliation(s)
| | - Rajesh Malhotra
- Corresponding author at: Room No 5019, Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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9
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Trans-foveal approach for curettage and bone grafting of a giant cell tumour in the femoral head. Hip Int 2016; 26:612-614. [PMID: 27740684 DOI: 10.5301/hipint.5000398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical access to benign neoplastic lesions of the femoral head are associated with significant morbidity, including contamination of intra-osseous access tracks, articular cartilage lesions, avascular bone necrosis or tumour recurrence due to incomplete curettage. CASE PRESENTATION We present a case of a 20-year-old female with a giant cell tumour in the femoral head, which was treated with curettage through a trans-foveal approach and bone grafting. This technique includes a surgical dislocation of the hip with trochanteric osteotomy. RESULTS At the latest follow-up at 2 years, there was no evidence of local recurrence or avascular necrosis on MRI, and the patient was pain free and back to sports.
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10
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Leute PJF, Hoffmann I, Hammad A, Lakemeier S, Klinger HM, Baums MH. Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement. J Orthop Traumatol 2016; 18:111-120. [PMID: 27535061 PMCID: PMC5429249 DOI: 10.1007/s10195-016-0426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 08/02/2016] [Indexed: 11/24/2022] Open
Abstract
Background Aseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement. Materials and methods A consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic. Results Twenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher’s exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003). Conclusions Smoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement. Level of evidence Level 4 according to Oxford Centre of Evidence-Based Medicine 2011. Electronic supplementary material The online version of this article (doi:10.1007/s10195-016-0426-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philip J F Leute
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Isabel Hoffmann
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Ahmed Hammad
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Stefan Lakemeier
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Hans-Michael Klinger
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Mike H Baums
- Department of Orthopedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Department of Orthopedic Surgery, Helios Aukammklinik, Leibnizstraße 21, 65191, Wiesbaden, Germany
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Gosal GS, Boparai A, Makkar GS. Long-Term Outcome of Endoprosthetic Replacement for Proximal Femur Giant Cell Tumor. Niger J Surg 2015; 21:143-5. [PMID: 26425070 PMCID: PMC4566322 DOI: 10.4103/1117-6806.162583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Giant cell tumor (GCT) of bone is locally aggressive benign tumor involving the epiphysis of long bones in young adults. Various treatment options include intralesional curettage, extended curettage, wide resection, resection and reconstruction and amputation. The main variables to be considered for planning treatment include the site of involvement and Campanacci stage of the tumor. Functional and oncological outcomes of these treatment options vary widely, the predominant detrimental factor being tumor recurrence rate. AIM A study was conducted to evaluate the long-term oncological and functional outcome of patients with GCT of the proximal femur that underwent tumor resection and endoprosthetic replacement. MATERIALS AND METHODS Eleven patients with Campanacci stage-III GCT of proximal femur who underwent wide excision of tumor and endoprosthesis replacement with a mean follow-up the duration of 10.6 years were assessed using standard proforma. The treatment outcome was evaluated using the Revised Musculoskeletal Tumor Society Rating Scale for the lower extremity. RESULTS At mean follow-up the duration of 10.6 years, none of the cases had tumor recurrence, infection, prosthesis loosening or dislocation. All the patients were community ambulators among whom eight patients were walking without support while three patients were using a cane for support. The mean total Musculoskeletal Tumor Society Score was 26.8 out of 30 indicating the good outcome. CONCLUSIONS The authors recommend that wide resection and endoprosthetic replacement should be considered as a preferred treatment option for proximal femur GCT as the functional, and oncological outcome is satisfactory with this modality of treatment.
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Affiliation(s)
- Gurinder Singh Gosal
- Department of Orthopaedics, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Avneet Boparai
- Department of Pathology, SRL Diagnostics, Amritsar, Punjab, India
| | - Gurpreet Singh Makkar
- Department of Orthopaedics, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Punjab, India
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Gaston CL, Puls F, Grimer RJ. The dilemma of denosumab: Salvage of a femoral head giant cell tumour. Int J Surg Case Rep 2014; 5:783-6. [PMID: 25290381 PMCID: PMC4245664 DOI: 10.1016/j.ijscr.2014.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Denosumab is a monoclonal RANKL antibody which has been shown to be highly effective in treating giant cell tumour (GCT) of bone. We report on its use as a neo-adjuvant agent to avoid morbid surgery for an adolescent. PRESENTATION OF CASE We report a case of a15-year old female with a Campanacci 3 GCT involving the femoral head and neck. DISCUSSION To preserve bone stock and avoid an outright hip replacement, the patient was given denosumab pre-operatively to consolidate the tumour. After receiving 6 months of treatment, a rim of cortical bone had developed to allow an extended curettage of the tumour to be performed without fear of collapse of the articular surface. CONCLUSION This is the first reported case of the use of denosumab in GCT of the femoral head and neck. We describe our experience in the neo-adjuvant use of denosumab and offer suggestions for future use. Further studies will be needed to see if denosumab has a role in conventional GCT and whether it can lead to a lowering of local recurrence rates.
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Affiliation(s)
- Czar Louie Gaston
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK.
| | - Florian Puls
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - Robert John Grimer
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
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13
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Wijsbek AE, Vazquez-Garcia BL, Grimer RJ, Carter SR, Abudu AA, Tillman RM, Jeys L. Giant cell tumour of the proximal femur. Bone Joint J 2014; 96-B:127-31. [DOI: 10.1302/0301-620x.96b1.31763] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to assess whether the use of a joint-sparing technique such as curettage and grafting was successful in eradicating giant cell tumours of the proximal femur, or whether an alternative strategy was more appropriate. Between 1974 and 2012, 24 patients with a giant cell tumour of the proximal femur were treated primarily at our hospital. Treatment was either joint sparing or joint replacing. Joint-sparing treatment was undertaken in ten patients by curettage with or without adjunctive bone graft. Joint replacement was by total hip replacement in nine patients and endoprosthetic replacement in five. All 11 patients who presented with a pathological fracture were treated by replacement. Local recurrence occurred in five patients (21%): two were treated by hip replacement, three by curettage and none with an endoprosthesis. Of the ten patients treated initially by curettage, six had a successful outcome without local recurrence and required no further surgery. Three eventually needed a hip replacement for local recurrence and one an endoprosthetic replacement for mechanical failure. Thus 18 patients had the affected joint replaced and only six (25%) retained their native joint. Overall, 60% of patients without a pathological fracture who were treated with curettage had a successful outcome. Cite this article: Bone Joint J 2014;96-B:127–31.
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Affiliation(s)
- A. E. Wijsbek
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - B. L. Vazquez-Garcia
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. J. Grimer
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - S. R. Carter
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - A. A. Abudu
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
| | - L. Jeys
- Royal Orthopaedic Hospital, Bristol
Road South, Northfield, Birmingham
B31 2AP, UK
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