Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction

Abstract

The management of bone defects following simple curettage of bone tumors is controversial and in light of the numerous emerging substitutes for bone grafts, we wished to review and report our experience with the use of cancellous allograft bone in the treatment of benign and borderline bone tumors. Methods: We reviewed the medical records of 164 consecutive patients with benign or borderline bone tumors treated with simple curettage at our orthopedic oncology center between 2009 and 2013. Postoperative radiological changes were evaluated by a modified Neer's classification in defects that were subsequently reconstructed with allograft bone (n ¼ 133). Results: Simple curettage with subsequent defect filling using allograft bone was the surgical procedure performed in the majority of our patients (81%) and was associated with a low overall 2.5-year local recurrence (LR; 9.8%) and complication rate (7.5%). The radiological appearance of the grafted defects was deemed satisfactory in 85% of cases, with signs of either complete or partial healing present 6-12 months postoperatively. With respect to pathology, we found high rates of LR in giant cell tumors (GCTs) of bone, simple cysts (SCs) in children, and preexisting local recurrent disease. We did not observe any allograft-related complications. Conclusions: Simple curettage and bone defect reconstruction with bone allograft is a sufficient treatment for most benign bone lesions and is associated with a low complication rate. For high-risk entities, such as GCTs of bone, SCs in children, and recurrent disease, additional adjuvant treatment could be considered to avoid LR.

Longitudinal in vivo biodistribution of nano and micro sized hydroxyapatite particles implanted in a bone defect

“…Microparticulate HA based biomaterials have been approved and clinically used in patients with bone defects arising after fractures, infections and bone tumors ( Fernandez de Grado et al, 2018 ; Horstmann et al, 2018 ). The systemic and local usage of HA nanoparticles has however been a subject of debate due to concerns regarding the risk of particle migration and accumulation leading to off-target cytotoxicity.…”

Study on Key Technologies of Virtual Interactive Surgical Simulation for 3D Reconstruction of Medical Images

“…At present, the CT, MRI, and 3D reconstruction technologies have become an important means of auxiliary diagnosis and treatment [ 18 , 19 ]. Medical experts can watch film diagnosis and treatment anytime and anywhere, remote operation guidance, remote consultation, and so on.…”

The current standing on the use of denosumab in giant cell tumour of the bone

“…22 GCTB are commonly treated by extended curettage, which comprises thorough bone curettage followed by use of a high-speed burr and may be augmented with use of local adjuvants such as phenol, liquid nitrogen, and polymethylmethacrylate cement (PMMA). 23 It is debatable if adjuvants help decrease the recurrence rates 24 though some studies have documented PMMA helping to lower the risk of local recurrence. 25 Wide resection poses the lowest risk of local recurrence as the whole tumour is removed but does increase the morbidity of the surgery and may result in reduced functional outcomes.…”