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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 302 - 302
1 Sep 2012
Van Der Heijden L Van De Sande M Nieuwenhuijse M Dijkstra P
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Background

Giant cell tumours of bone (GCT) are benign bone tumours with a locally aggressive character. Local recurrence is considered the main complication of surgical treatment and is described in up to 50% of patients. Intralesional curettage with the use of adjuvants like phenol or polymethylmetacrylate (PMMA) is recommended as initial treatment, significantly decreasing the risk of recurrence. However, risk factors for local recurrence in skeletal GCT have not yet been firmly established and a golden standard for local therapy remains controversial.

Objective

The identification of risk factors predisposing for an increased risk of local recurrence. In addition, different surgical techniques are compared to identify the optimal surgical approach for the identified risk factors.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 167 - 167
1 Sep 2012
Sarac C Dijkstra S Taminiau A Nieuwenhuijse M Kroft L Van Der Linden E
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Introduction

An aneurysmatic bone cyst (ABC) is a benign cystic lesion of bone composed of blood-filled spaces separated by connective septa.

The most common treatment is curettage with or without bone grafting. Curettage with bone grafting and Ethibloc injection therapy have a comparable recurrence rate. Ethibloc is a radiopaque alcohol solution of corn protein which is percutaneously injected in the ABC.

Objective

To compare percutaneous Ethibloc injection (ETHI) with curettage with bone grafting (CUBG) in the treatment of ABC.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 320 - 320
1 Sep 2012
Nieuwenhuijse M Van Rijswijk C Van Erkel A Dijkstra S
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Objective

Comparison of clinical outcome after Percutaneous Vertebro Plasty (PVP) for Osteoporotic Vertebral Compression Fractures (OVCFs) between patients with and without Intra Vertebral Clefts (IVCs).

Background

PVP is a common treatment modality for painful OVCFs. Patients presenting with OVCFs with an IVC, also described as avascular necrosis of the vertebral body or intravertebral pseuadoarthrosis, are thought to represent a specific subgroup: filling the cleft might result in immediate and possibly superior pain relief due to stabilization of the excessive mobility associated with an IVC and the risk for cement leakage might be decreased due to its cavitational nature.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 142 - 142
1 May 2011
Nieuwenhuijse M Muijs S Van Erkel A Dijkstra S
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Study Design: Comparative, prospective follow-up study.

Objective: Comparison of outcome between patients treated with Percutaneous VertebroPlasty (PVP) using low viscosity PolyMethylMetAcrylate (PMMA) bone cement and patients treated with PVP using medium viscosity PMMA bone cement. Summary of background data. Viscosity is the characterizing parameter of PMMA bone cement, currently the standard augmentation material in PVP, and influences interdigitation and cement distribution inside the vertebral body, injected volume and extravasation, thereby affecting the clinical outcome of PVP. In PVP, low, medium and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity of cement on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation.

Methods: Follow-up was conducted using a 0–10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) Quality of Life (QoL) questionnaire before PVP and at 7 days (PI-NRS only), 1 month, 3 months and 12 months after PVP. Cement leakage was analyzed on direct post-operative CT-scanning. Injected cement volume was measured using a calibrated DICOM-viewer and the degree of interdigitation was assessed. At six and 52 weeks and at suspicion, patients were analyzed for the incidence of new fractures.

Results: Thirty consecutive patients received PVP using low viscosity PMMA bone cement (OsteoPal-V®) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-Tech®) for 67 OVCFs. Baseline characteristics were comparable between groups. Viscosity qualification was stated by the manufacturer. results regarding PI-NRS and SF-36 were comparable between both groups. Postoperative comparison of injected cement volume, degree of interdigitation, proportion of bipedicular procedures, incidence of new vertebral fractures and complications revealed no substantial differences between both groups. In the low viscosity group a significantly greater proportion of vertebrae showed cement extravastion (81,0% versus 71,6%, p = 0,029).

Multiple logistic analysis revealed no definitive predictive factors for the occurrence of cement leakage (yes/ no) (Odds Ratio [95% CI], P):

Severity (acc to Genant et al): 1.82 [0,69 – 4.89], 0.229

Fracture Type (Genant et al): 1.22 [0.64 – 2.32], 0.550

Injected Volume: 0.98 [0.76 – 1.27], 0.875

Spinal Region: 0.87 [0.48 – 1.55], 0.628

Cement Viscosity: 0.42 [0.16 – 1.10], 0.076

Conclusion: No major differences in clinical outcome after PVP in OVCFs using low and medium viscosity PMMA bone cement were found. Viscosity of PMMA bone cement is likely to influence cement extravastion, although this could not be confirmed.