Remodeling of large bone defects in the treatment of space-occupying lesions

Abstract

Curettage without bone graft was performed in 17 patients with benign bone tumors and tumor-like lesions. New bone formation with uniformly increased radiodensity appeared in serial plain radiographs within 3 months after the operation. The average period before full weight could be borne on the lower extremities was 14 weeks. Computed tomography revealed that the central part of the bone lesions persisted without bone formation. The thickening of cortical bone was predominant. These data indicate that enough mechanical strength for daily activity will be recovered by bone within 4 months after curettage without any filler, although remodeling continues for over a year. It is suggested that bone graft and implantation of "biomaterials" are not necessary in patients, especially younger ones, with benign bone tumors or tumorous conditions.

Simple Curettage without Bone Grafting for Enchondromata of the Hand: With Special Reference to Replacement of the Cortical Window

“…There is no doubt that new bone formation and remodelling do occur in the bone defect following curettage without bone grafting (Chigira et al, 1992;Hasselgren et al, 1991;Noble and Lamb, 1974;Takigawa, 1971;Tordai et al, 1990;Wulle, 1990). However, the rationale for bone grafting is to (i) minimize the volume of the bone defect, (ii) maintain bone strength, (iii) encourage new bone formation and the early acquisition of bone strength.…”

Curettage of benign bone tumors without grafts gives sufficient bone strength

“…Chigira et al (1992) curetted benign bone tumors in different locations without filling and, even in large defects, they found bone remodeling with sufficient strength for daily activity. Waldram and Sneath (1989) stated that bone grafting is not necessarily required after curettage of a giant cell tumor.…”

Salvage of the proximal femur following pathological fractures involving benign bone tumors

“…Some authors have advocated leaving the bone cavity empty following curettage, even in weight-bearing bones, as the curetted space is seen to fill with new bone which consolidates over time [8,22,45,46]. Prosser et al examined the outcomes for 193 GCT, 137 of whom were treated with primary curettage without filling the defect and described a local recurrence rate of 19% [8].…”

“…Yanagawa et al [22] investigated 78 benign bone tumors in various anatomic locations treated without bone grafting and reported an 11.5% local recurrence rate and 3.8% postoperative fracture rate. Chigira et al [46] reported that new bone formation in the cavity following curettage alone appeared on radiographs within 3 months, with 14 weeks being the average time that patients with lower extremity lesions returned to full weight-bearing. Hirn et al reported a much shorter mean time of 6 weeks to full weight-bearing [45].…”