BACKGROUND: Lesion scraping and bone cement filling is the first choice for treatment of giant cell tumor of bone around the knee joint, but bone cement filling will increase articular cartilage damage and cause osteoarthritis. Clinicians generally choose subchondral bone grafting to avoid articular cartilage damage, but there is currently a lack of objective research evidence on subchondral bone grafting and no bone grafting for this procedure.
OBJECTIVE: To compare the effect of subchondral bone grafting and no bone grafting on functional recovery of giant cell tumor of bone around the knee after expanded and curettage and to analyze the risk factors for secondary osteoarthritis.
METHODS: A total of 47 patients with giant cell tumor of bone around the knee who were admitted to Foshan Hospital of Traditional Chinese Medicine from 2014 to 2019 were enrolled, including 16 males and 31 females aged 19-65 years. They were divided into a bone grafting group (n=25) and a non-bone grafting group (n=22) according to whether subchondral bone grafting was performed during bone cement filling after extended curettage of the lesion. The patients were followed up for more than 5 years after surgery. The Musculoskeletal Tumor Society score, range of motion of the knee joint, tumor recurrence rate, and incidence of osteoarthritis during follow-up were compared between the two groups. After excluding recurrent cases, the patients were evaluated for secondary osteoarthritis according to the Aboulafia grading system and divided into groups. Univariate Logistic regression analysis was performed on gender, age, body mass index, tumor location, tumor cavity range, Campanacci grade, whether pathological fracture was combined, whether subchondral bone grafting was performed, Musculoskeletal Tumor Society score, tumor-cartilage distance and other variables between the two groups, and multivariate Logistic regression analysis was performed.
RESULTS AND CONCLUSION: (1) There was no significant difference in Musculoskeletal Tumor Society score and range of motion of knee joint between the bone grafting group and the non-bone grafting group 5 years after surgery (P > 0.05). During the follow-up period, three cases of tumor recurrence occurred in the bone grafting group and two cases in the non-bone grafting group. There was no significant difference in tumor recurrence rate between the two groups
(P > 0.05). The incidence of secondary osteoarthritis in the bone grafting group was significantly lower than that in the non-bone grafting group (16%, 50%, P < 0.05). (2) The univariate Logistic regression analysis showed that there were significant differences in Musculoskeletal Tumor Society score, tumor-cartilage distance, tumor cavity range, pathological fracture, and subchondral bone grafting between the secondary osteoarthritis group (n=15) and the non-secondary osteoarthritis group (n=27) (P < 0.05). The multivariate Logistic regression analysis showed that tumor-cartilage distance, tumor cavity range, pathological fracture, and subchondral bone grafting were risk factors for long-term secondary osteoarthritis after surgery (P < 0.05). (3) The results showed that there was no significant difference in the effect of subchondral bone grafting and no bone grafting on the recovery of knee joint function in patients with giant cell tumor of the knee joint during the surgery of lesion enlargement, scraping and bone cement filling, but subchondral bone grafting can reduce cartilage damage. Among them, too small tumor-cartilage distance, too large tumor cavity, combined pathological fracture, and no subchondral bone grafting are risk factors for secondary osteoarthritis in the later stage.