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• W3041277897 abstract "Where Are We Now? According to the most-recent WHO classification of tumors of soft tissue and bone, giant cell tumor of bone (GCTB) is an aggressive, rarely metastasizing, intermediate-grade bone tumor [16]. It is usually a metaepiphyseal lesion, and its treatment can be complicated when it destroys cortical bone and grows into the soft tissues (a presentation that is defined as Campanacci Grade 3 [5]). In this scenario, there is often a dilemma about the type of surgery to be used; typically, the choices include intralesional resection, which preserves the joint, and en-bloc resection, which is typically accompanied by reconstruction with an osteoarticular allograft or a prosthetic implant. With the recent use of denosumab (a RANKL inhibitor) as preoperative treatment, patients with a good response who were previously treated with endoprosthetic replacements may be treated with intralesional procedures, thus saving the joint [13, 15], but use of denosumab in this setting has been associated with an increased risk of local recurrence [11, 14]. The advantages of osteoarticular allografts include its biologic nature, lower financial cost, and good long-term results [9]. However, osteoarticular allografts have some important shortcomings, particularly complications such as fracture, infection, and nonunion. In the long term, there is also the concern of joint degeneration resulting in prosthetic replacement [12]. Endoprosthetic reconstructions have a relatively easy technique and excellent short-term and middle-term results [10]. On the other hand, prosthetic reconstruction after en bloc resection of a GCTB is associated with substantial long-term complications such as aseptic loosening, mechanical failure, and infection, frequently resulting in extensive revision surgeries [6]. The current study by Albergo et al. [2] analyzed 39 osteoarticular allografts in patients with Grade 3 GCTBs and evaluated the long-term survival of patients who underwent reconstruction. The study demonstrated that it is possible to obtain outstanding results using osteoarticular allografts in patients with advanced GCTBs. Based on their findings, surgeons might consider using this technique if they believe biologic reconstructions perform better than prosthetic ones do, and if they have the required resources available. Where Do We Need To Go? What are the reasons for the different results between Albergo et al.’s study [2] and others [4, 7]? The allograft harvesting technique and implant selection may be two reasons. Preserving the ligament stumps, tendons, and capsule when harvesting the graft may have an important impact on the overall result. Additionally, CT-based, virtual three-dimensional (3-D) models of the allografts and the proper selection of the best-matched graft using mirrored contralateral 3-D models may have an important impact on the results of osteoarticular allograft reconstruction. Another issue is the surgical technique, including ligament and capsule reconstruction and preservation of the menisci. This suggests that future studies need to pay specific attention to how allografts are harvested. It also seems important to reconcile the fact that one center seems to do very well with osteoarticular allografts [2, 3], while a number of others do not [4, 7, 8]. As we do so, we need to be mindful of the practical problems associated with both reconstructive options; endoprosthetic reconstruction systems may be too expensive for routine use in many resource-constrained locations, while allograft banking is not universally available, and cultural or religious issues may affect the applicability of this approach (for example, in Eastern countries such as Japan, allografts are not widely used [1]). Future studies should help us characterize the trade-offs of each approach—osteoarticular allograft and prosthetic reconstruction—that surgeons use to treat a GCTB when it destroys cortical bone near a major joint. How Do We Get There? Randomized trials on this topic are impractical. Registry-based research is more feasible. Prospective and retrospective studies would probably be easier than randomized trials if databases designed in consensus meetings were widespread and if data were gathered and analyzed by an assigned team. These questions would be addressed more easily and answered more quickly with reliable and uniform data gathering. In the near future, the effort of combining the most-prominent musculoskeletal oncology centers globally will probably be the key to developing uniform databases, and therefore collecting reliable data with enough numbers to support changes in the way we treat musculoskeletal tumors. Leaders of various musculoskeletal tumor societies must encourage this kind of action for our field to advance in the ways we know it needs to; practice that is based not only on personal experience, but also on consistent scientific material." @default.
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• W3041277897 date "2020-07-03" @default.
• W3041277897 modified "2023-09-27" @default.
• W3041277897 title "CORR Insights®: Does Osteoarticular Allograft Reconstruction Achieve Long-term Survivorship after En Bloc Resection of Grade 3 Giant Cell Tumor of Bone?" @default.
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• W3041277897 doi "https://doi.org/10.1097/corr.0000000000001401" @default.
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