title: Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications.
abstract: BACKGROUND
  Giant cell tumors (GCTs) are treated with resection curettage and adjuvants followed by stabilization. Complications include recurrence, fracture, and joint degeneration. Studies have shown treatment with polymethylmethacrylate (PMMA) may increase the risk of joint degeneration and fracture. Other studies have suggested that subchondral bone grafting may reduce these risks.
  
  
  OBJECTIVE
  Following standard intralesional resection-curettage and adjuvant treatment, is the use of bone graft, with or without supplemental PMMA, (1) associated with fewer nononcologic complications; (2) associated with differences in tumor recurrence between patients treated with versus those treated without bone grafting for GCT; and (3) associated with differences in Musculoskeletal Tumor Society (MSTS) scores?
  
  
  METHODS
  Between 1996 and 2014, 49 patients presented with GCT in the epiphysis of a long bone. Six patients were excluded, four who were lost to followup before 12 months and two because they presented with displaced, comminuted, intraarticular pathologic fractures with a nonreconstructable joint surface. The remaining 43 patients were included in our study at a mean followup of 59 months (range, 12-234 months). After resection-curettage, 21 patients were reconstructed using femoral head allograft with or without PMMA (JB) and 22 patients were reconstructed using PMMA alone (FRP, KSB); each surgeon used the same approach (that is, bone graft or no bone graft) throughout the period of study. The primary study comparison was between patients treated with bone graft (with or without PMMA) and those treated without bone graft.
  
  
  RESULTS
  Nononcologic complications occurred less frequently in patients treated with bone graft than those treated without (10% [two of 21] versus 55% [12 of 22]; odds ratio, 0.088; 95% confidence interval [CI], 0.02-0.47; p = 0.002). Patients with bone graft had increased nononcologic complication-free survival (hazard ratio, 4.59; 95% CI, 1.39-15.12; p = 0.012). With the numbers available, there was no difference in tumor recurrence between patients treated with bone graft versus without (29% [six of 21] versus 32% [seven of 22]; odds ratio, 0.70; 95% CI, 0.1936-2.531; p = 0.586) or in recurrence-free survival among patients with bone graft versus without (hazard ratio, 0.94; 95% CI, 0.30-2.98; p = 0.920). With the numbers available, there was no difference in mean MSTS scores between patients treated with bone graft versus without (92% ± 2% versus 93% ± 1.4%; mean difference 1.0%; 95% CI, -3.9% to 6.0%; p = 0.675).
  
  
  CONCLUSIONS
  Compared with PMMA alone, the use of periarticular bone graft constructs reduces postoperative complications apparently without increasing the likelihood of tumor recurrence.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA. benevejo@njms.rutgers.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Benevenia
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Rivero
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ippolito
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Siegerman
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Beebe
authors.affiliation: Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ, 07103, USA.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D016025:Bone Transplantation / Q000009:adverse effects; D003475:Curettage; D018572:Disease-Free Survival; D004838:Epiphyses / Q000473:pathology / Q000601:surgery; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000517:prevention & control; D005266:Femoral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005270:Femur Head / Q000000981:diagnostic imaging / Q000637:transplantation*; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D010003:Osteoarthritis / Q000209:etiology / Q000517:prevention & control; D010027:Osteotomy; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011884:Radius / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011885:Radius Fractures / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013978:Tibial Fractures / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate