Clinical Studies Of Bone Cement Filling Effect On The Articular Cartilage Of The Knee After Curettage Of Bone Giant Cell Tumor

Objective:The aim of this retrospective study was to evaluate articular cartilage injury after curettage followed by bone cement filling of the giant cell tumor around the knee.Methods:Fifty-three patients (30males and23females,28cases of distal femur and25cases of proximal tibia) were included in this follow-up study.42patients underwent curettage followed by bone cement filling, and11patients had curettage followed by with bone grafts in the subchondral bony area and then filled with bone cement. The mean age at first diagnosis was34.2±11.4years (16-69years). According to Campanacci grade, there were15patients in grade Ⅰ,39in grade Ⅱ and9in grade Ⅲ. The study carried out in two steps. First, analyze the factors difference between arthritis and osteoarthritis not occurring. According to the statistical results for the first time, in the high-risk population in arthritis, analyze the factors difference between the subchondral bone graft and without bone graft.Results:The average follow-up time was65months (range,23-158months). Of53cases,37had (69.8%) no osteoarthritis, and16(30.2%) had secondary osteoarthritis. Three cases (5.7%) recurred during the follow-up period. Single factor analysis showed no significant difference in gender, age, tumor location, and Campanacci grade between2groups (P>0.1); difference was significant in the subchondral bone thickness, tumor cross section, Enneking function evaluation, and subchondral bone graft (P<0.1). The multiariable logistic regression analysis showed that the decreased subchondral residual tumor thickness, the increased residual tumor cross section, and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis (P<0.05).Conclusion:GCT patients with less residual thickness of the subchondral bone and big size tumor are more likely to develop degenerative arthritis after curettage. Sometimes X-ray does not show signs of arthritis, but doesn’t mean cartilage is complete. The subchondral bone grafts establish buffer between cement and cartilage can reduce or delay the cartilage damage. When distal femur tumors cross section is more than50%of the host bone and has been completely to joint margins of postoperative can appear serious joint degeneration in the short term, we suggested the outset resection and joint replacement.