Efficacy of cerament in large defects created by giant cell tumor

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 10-13 | Rizwan Khan, Javed Jameel.

Authors: Rizwan Khan [1], Javed Jameel [1].

[1] Department of Orthopedics, HIMSR, Jamia Hamdard, New Delhi 110062.

Address of Correspondence
Dr. Javed Jameel,

Department of Orthopaedics, HIMSR,

Jamia Hamdard, New Delhi 110062

E-mail: drjavedjameel@gmail.com


Background: Giant cell tumors are an aggressive and potentially malignant lesion that is commonly treated by surgery involving bone grafts or synthetic bone void fillers. Although synthetic bone grafts may provide early mechanical support while minimizing the risk of donor-site morbidity and disease transmission, difficult manipulation and less than optimal transformation to bone have limited their use.

Materials and Methods: In a prospective series, 14 patients of giant cell tumour with a mean age of 25 years (20–30 years range) were treated by extended curettage followed by the use of a biphasic (composed of two components 60% weight synthetic calcium sulfate and 40% weight hydroxyapatite powder) and injectable ceramic bone substitute (CEMENT™ BONE VOID FILLER, BoneSupport, Sweden). The most common location was proximal tibia (n = 6), followed by distal end of femur (n = 5), distal end humerus (n = 2), and distal end of radius (n = 1). Patients were followed clinically and radiologically for 6 months. Serial X-rays were performed thereafter to look for recurrence and bone remodeling of the bone substitute. All lower limb patients were allowed partial weight bearing immediately after surgery. All upper limb patients were allowed the active gentle range of movement exercises after surgery.

Results: Lesion started bone remodeling by 2–3 months. After 6 months, the defects completely demonstrated full resolution. A serous discharge, probably response to cerament, was noted in all patients postoperatively that resolved within 2–3 weeks spontaneously. No lesions required revision surgery during the observation period. No post-operative fracture or infection was recorded.

Conclusions: Extended curettage followed by high-speed cuing bur and cavity lavage with appropriate irrigants primary to the use of biphasic and injectable ceramic bone substitute might offer an alternative to regular bone graing due to convenient handling properties and rapid bone remodeling.

Key words: Cerament, giant cell tumor, large defects.


1. Schajowicz F. Histological Typing of Bone Tumours. Berlin: Springer-Verlag; 1993. p. 20-2.
2. Szendröi M. Giant-cell tumour of bone. J Bone Joint Surg Br 2004;86:5-12.
3. Remedios D, Saifuddin A, Pringle J. Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br 1997;79:26-30.
4. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ, et al. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 1994;76:1827-33.
5. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res 1995;321:245-50.
6. Kaczmarczyk J, Sowinski P, Goch M, Katulska K. Complete twelve month bone remodeling with a bi-phasic injectable bone substitute in benign bone tumors: A prospective pilot study. BMC Musculoskelet Disord 2015;16:369.
7. Dürr HR, Maier M, Jansson V, Baur A, Refior HJ. Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol 1999;25:610-8.
8. Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res 1998;347:250-60.
9. Puri A, Agarwal M. Treatment of giant cell tumor of bone: Current concepts. Indian J Orthop 2007;41:101-8.
10. Nelson DA, Barker ME, Hamlin BH. Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia 1997;13:287-306.
11. Kirchen ME, Menendez LR, Lee JH, Marshall GJ. Methotrexate eluted from bone cement: Effect on giant cell tumor of bone in vitro. Clin Orthop Relat Res 1996;328:294-303.
12. Zhang Y, Hou C, Chen A. A preliminary clinical observation of giant cell tumor of bone treated by adriamycin-loaded chitosan drug delivery system. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 1998;12:280-2.
13. Dreinhöfer KE, Rydholm A, Bauer HC, Kreicbergs A. Giant-cell tumours with fracture at diagnosis. Curettage and acrylic cementing in ten cases. J Bone Joint Surg Br 1995;77:189-93.
14. Alkalay D, Kollender Y, Mozes M, Meller I. Giant cell tumors with intraarticular fracture. Two-stage local excision, cryosurgery and cementation in 5 patients with distal femoral tumor followed for 2-4 years. Acta Orthop Scand 1996;67:291-4.
15. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y, et al. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res 1999;359:176-88.
16. Schreuder HW, Keijser LC, Veth RP. Beneficial effects of cryosurgical treatment in benign and low-grade-malignant bone tumors in 120 patients. Ned Tijdschr Geneeskd 1999;143:2275-81.
17. Evaniew N, Tan V, Parasu N, Jurriaans E, Finlay K, Deheshi B, et al. Use of a calcium sulfate-calcium phosphate synthetic bone graft composite in the surgical management of primary bone tumors. Orthopedics 2013;36:e216-22.
18. Abramo A, Geijer M, Kopylov P, Tägil M. Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate. J Biomed Mater Res B Appl Biomater 2010;92:281-6.
19. Lee C. The Mechanical Properties of PMMA Bone Cement. Berlin Heidelberg: Springer; 2005. p. 60-6.
20. Schindler OS, Cannon SR, Briggs TW, Blunn GW. Composite ceramic bone graft substitute in the treatment of locally aggressive benign bone tumours. J Orthop Surg (Hong Kong) 2008;16:66-74.

How to Cite this Article: Khan R, Jameel J. Efficacy of cerament in large defects created by giant cell tumor. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):10-13.

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