Function after injection of benign bone lesions with a bioceramic

Abstract

Background: A novel calcium sulfate-calcium phosphate composite injectable bone graft substitute has been approved by the FDA for filling bone defects in a nonweightbearing application based on preclinical studies. Its utility has not been documented in the literature.

Questions/purposes: We therefore determined postoperative function and complications in patients with benign bone lesions treated with this bioceramic.

Methods: We retrospectively reviewed all 56 patients with benign bone lesions treated with the bioceramic from 2006 to 2008. There were 29 male and 27 female patients with an average age of 17.6 years (range, 4-63 years). They were treated for the following diagnoses: unicameral bone cyst (13), aneurysmal bone cyst (10), nonossifying fibroma (eight), fibrous dysplasia (five), enchondroma (four), chondroblastoma (four), and other (12). We obtained a Musculoskeletal Tumor Society (MSTS) functional evaluation on all patients. The minimum followup was 26 months (average, 42 months; range, 26-57 months).

Results: The average MSTS score was 29 (range, 20-30). Most patients returned to normal function. There were three local recurrences, all of which were treated with repeat injection or curettage. Two patients had postoperative fractures treated in a closed manner. Two patients had wound complications, neither of which required removal of the graft material.

Conclusion: Patients treated with this material reported high MSTS functional scores more than 24 months after operative intervention and experienced low complication rates. We believe the novel bioceramic to be a reasonable treatment option for benign bone lesions.

Fig. 1A−C

(A) A preoperative radiograph shows a unicameral bone cyst in a 12-year-old boy. (B) A 1-month postoperative radiograph after percutaneous injection of PRO-DENSE^® graft material is shown. (C) The 2-month postoperative radiograph shows ceramic degradation and bone formation.

Fig. 2A–B

(A) The graft is prepared intraoperatively on the back table by mixing the powdered graft materials with an aqueous diluent. (B) The resulting composite then is injected into the lesion through a cannula with a separate cannula used as a vent. The graft is injectable for approximately 5 minutes and sets up in 20 to 30 minutes.

Fig. 3A–B

(A) A postoperative radiograph is shown after open curettage and grafting of a distal tibial aneurysmal bone cyst in a 13-year-old girl. (B) A radiograph obtained 1 year after surgery shows degradation of the ceramic and bony remodeling.

Fig. 4

A CT scan obtained 19 months after percutaneous injection of PRO-DENSE^® graft material in the proximal humerus unicameral bone cyst of a 12-year-old boy (patient in figures 1A–C) shows full degradation of the ceramic material with complete bone repair.