Potential for thermal damage to articular cartilage by PMMA reconstruction of a bone cavity following tumor excision: A finite element study |
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| Authors: | Boyko R. Radev Jonathan A. Kase Michael J. Askew Scott D. Weiner |
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| Affiliation: | 1. Radius Health, Waltham, MA, USA;2. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA;3. Division of Bone and Mineral Research, Dept of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA;4. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA;5. Harvard Medical School and Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA;1. Musculoskeletal Biology and Mechanics Lab, Department of Basic Medical Sciences, Purdue University, IN, USA;2. School of Mechanical Engineering, Purdue University, IN, USA;3. Weldon School of Biomedical Engineering, Purdue University, IN, USA;4. Department of Aerospace and Mechanical Engineering, University of Notre Dame, IN, USA |
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| Abstract: | Benign, giant cell tumors are often treated by intralesional excision and reconstruction with polymethylmethacrylate (PMMA) bone cement. The exothermic reaction of the in-situ polymerizing PMMA is believed to beneficially kill remaining tumor cells. However, at issue is the extent of this necrotic effect into the surrounding normal bone and the adjacent articular cartilage. Finite element analysis (ABAQUS 6.4-1) was used to determine the extent of possible thermal necrosis around prismatically shaped, PMMA implants (8–24 cc in volume), placed into a peripheral, sagittally symmetric, metaphyseal defect in the proximal tibia. Temperature/exposure time conditions indicating necrotic potential during the exotherm of the polymerizing bone cement were found in regions of the cancellous bone within 3 mm of the superior surface of the PMMA implant. If less than 3 mm of cancellous bone existed between the PMMA implant and the subchondral bone layer, regions of the subchondral bone were also exposed to thermally necrotic conditions. However, as long as there were at least 2 mm of uniform subchondral bone above the PMMA implant, the necrotic regions did not extend into the overlying articular cartilage. This was the case even when the PMMA was in direct contact with the subchondral bone. If the subchondral bone is not of sufficient thickness, or is not continuous, then care should be taken to protect the articular cartilage from thermal damage as a result of the reconstruction of the tumor cavity with PMMA bone cement. |
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