Surgical therapy of benign and low-grade malignant intramedullary chondroid lesions of the distal femur: intralesional resection and bone cement filling with or without osteosynthesis

Abstract

Surgical treatment of benign and low-grade malignant intramedullary chondroid lesions at the distal femur is not well analyzed compared to higher-grade chondrosarcomas. Localization at the distal femur offers high biomechanical risks requiring sophisticated treatment strategy, but scientific guidelines are missing. We therefore wanted to analyze a series of equally treated patients with intralesional resection and bone cement filling with and without additional osteosynthesis. Twenty-two consecutive patients could be included with intralesional excision and filling with polymethylmethacrylate bone cement alone (n = 10) or with compound bone cement osteosynthesis using a locking compression plate (n = 12). Clinical and radiological outcome was retrospectively evaluated including tumor recurrences, complications, satisfaction, pain, and function. Mean follow-up was 55 months (range 7–159 months). Complication rate was generally high with lesion-associated fractures both in the osteosynthesis group (n = 2) and in the non-osteosynthesis group (n = 2). All fractures occurred in lesions that reached the diaphysis. No fractures were found in meta-epiphyseal lesions. No tumor recurrence was found until final follow-up. Clinical outcome was good to excellent for both groups, but patients with additional osteosynthesis had significantly longer surgery time, more blood loss, longer postoperative stay in the hospital, more complications, more pain, less satisfaction, and worse functional outcome. Intralesional resection strategy was oncologically safe without local recurrences but revealed high risk of biomechanical complications if the lesion reached the diaphysis with an equal fracture rate no matter whether osteosynthesis was used or not. Additional osteosynthesis significantly worsened final clinical outcome and had more overall complications. This study may help guide surgeons to avoid overtreatment with additional osteosynthesis after curettage and bone cement filling of intramedullary lesions of the distal femur. Meta-epiphyseal lesions will need additional osteosynthesis rarely, contrary to diaphyseal lesions with considerable cortical thinning.

Cortical Window Reconstruction With Cement Augmented Screw Fixation After Intralesional Curettage of Low-Grade Chondrosarcomas: A Simple Method With Clinical Results

“…They recommended routine internal fixation after the procedure in order to prevent any pathological fracture and increase stabilisation. Omlor et al (10) found that complications were almost twice as high in patients with…”

“…However, there has been a debate about the surgical treatment method for lowgrade chondrosarcomas (LGC), since they are less aggressive and rarely metastasize (4)(5)(6). Intralesional treatment with or without a local adjuvant therapy is a widely preferred surgical method with a low rate of complications and recurrence (5)(6)(7)(8)(9)(10)(11). Although there are different types of local adjuvants, polymethylmethacrylate (PMMA) bone cement is one of the most common local adjuvants used after intralesional curettage (1,8).…”

“…While some authors believe that internal fixation should be considered in order to avoid pathological fracture risk, others found no difference between an additional osteosynthesis and the lack of it. Besides, there have recently been a number of reports related to the disadvantages of internal fixation with plate and screws (8,10,11).…”

Treatment Approach for Knee Osteoarthritis with Ipsilateral Femoral Cartilage Tumor: A Case Series

“…If no concomitant OA was present, current literature would propose observation of enchondromas, intralesional treatment for a low-grade cartilaginous tumor, and wide resection for intermediate and high-grade chondrosarcomas. 10 , 11 This case series presents an approach used at our institution for performing TKA in patients with knee OA and cartilaginous tumors of the ipsilateral distal femur.…”

Intralesional curettage and cementation of low-grade chondrosarcomas of the appendicular skeleton: Long-term results from a single center

“… 8 - 11 Recently, there has been an increasing trend toward the intralesional treatment of LGC, in terms of “less extensive,” “limited,” or “conservative” surgical treatment. 12 - 15 …”