Current status of bone cementing and bone grafting for giant cell tumour of bone: a systemic review

Abstract

Introduction: Extended intralesional curettage, together with bone grafting/cementing, is considered as a surgical treatment option for giant cell tumour of the bone. This study aimed to discover the efficacy and recurrence rate with the use of bone cement in giant cell tumour and to compare it with that of bone grafting.

Material and methods: The present systemic review is derived from the publications in the past 10 years (2009-2018). A literature search was performed via PubMed, using suitable keywords and Boolean operators database ('Giant cell tumor,' 'osteoclastoma,' 'bone,' 'bone cement,' 'bone graft' and 'curettage'). A detailed statistical analysis of the data derived from the published literature was done.

Results: The patients who underwent bone graft only exhibited significantly higher recurrence rates than those treated with polymethyl methacrylate only (risk ratio 1.90; 95% confidence interval 1.14, 3.16; overall effect Z = 2.488; P-value 0.012). The observational analysis was done in rest of the seven studies; three studies showed no recurrence rate. Only one study reported the highest recurrence rate of 42% and the remaining six had an overall recurrence rate of 20.4%.

Conclusion: The use of bone cement was associated with a statistically significantly lower recurrence rate than bone grafting in giant cell tumour of bones. We therefore recommend the use of bone cement with extensive intralesional curettage. Adjuvant therapy like electrocautery, phenol irrigation and the use of intravenous denosumab or bisphosphonates may help in decreasing the incidence of recurrence in giant cell tumour of bone.

Keywords: Bone cement; Bone graft; Curettage; Giant cell tumour; Polymethyl methacrylate.

Figure 1

Forest plot showing a comparative analysis of bone cement and bone graft in giant cell tumours.

Figure 2

Overall recurrence rates in various studies.