Curettage of benign bone tumors and tumor like lesions: A retrospective analysis

Abstract

Background:Curettage is one of the most common treatment options for benign lytic bone tumors and tumor like lesions. The resultant defect is usually filled. We report our outcome curettage of benign bone tumors and tumor like lesions without filling the cavity.Materials and Methods:We retrospectively studied 42 patients (28 males and 14 females) with benign bone tumors who had undergone curettage without grafting or filling of the defect by any other bone graft substitute. The age of the patients ranged from 14 to 66 years. The most common histological diagnosis was that of giant cell tumor followed by simple bone cyst, aneurysamal bone cyst, enchondroma, fibrous dysplasia, chondromyxoid fibroma, and chondroblastoma and giant cell reparative granuloma. Of the 15 giant cell tumors, 4 were radiographic grade 1 lesions, 8 were grade 2 and 3 grade 3. The mean maximum diameter of the cysts was 5.1 (range 1.1-9 cm) cm and the mean volume of the lesions was 34.89 cm3 (range 0.94-194.52 cm3). The plain radiographs of the part before and after curettage were reviewed to establish the size of the initial defect and the rate of reconstitution, filling and remodeling of the bone defect. Patients were reviewed every 3 monthly for a minimum period of 2 years.Results:Most of the bone defects completely reconstituted to a normal appearance while the rest filled partially. Two patients had preoperative and three had postoperative fractures. All the fractures healed uneventfully. Local recurrence occurred in three patients with giant cell tumor who were then reoperated. All other patients had unrestricted activities of daily living after surgery. The rate of bone reconstitution, risk of subsequent fracture or the incidence of complications was related to the size of the cyst/tumor at diagnosis. The benign cystic bone lesions with volume greater than approximately 70 cm3 were found to have higher incidence of complications.Conclusion:This study demonstrates the natural healing ability of bone without filling with bone grafts or bone graft substitutes. In selected sizes and locations of the benign lytic tumors and tumor like lesions extended curettage alone can be sufficient.

Safety, osseointegration, and bone ingrowth analysis of PMMA‐based porous cement on animal metaphyseal bone defect model

“…Another expected advantage is the compatibility between trabecular bone and porous cement elasticities. 19,20 Studies considering osteoconductive properties established the ideal pore size as around 100-400 lm in diameter. 15,18 Although, other authors suggest sizes ranging from 400 lm to 1.0 mm in diameter.…”

Author′s reply

“…We appreciate taking interest in our article[1] and raising concerns by Puri and Gulia. [2] Most of the issues raised are discussed in discussion section.…”

“…Further, we have observed that in the event of peroperative fracture in tumor like lesions (cysts), we have performed the intramedullary fixation and the cavity filled and healed well even without grafting. [1]…”

Evaluation of curettage, synthetic bone grafting and fixation with implant in benign osteolytic and cystic lesions of long bones in children and young adults

“…Rather it is the adequate exposure, histological type and curettage/removal of complete tumor cells followed by cauterizing the wall that is more important predictive factor for the successful outcome of surgery. 13 One study performed by AK Gupta et al 37 cases of benign bone tumour was curetted and filled with HA bone substitutes. 14 After 12 months of follow up five cases were in Irwin stage I, 13 were in Irwin stage II and 19 were in Irwin stage III.…”