Chondroblastoma in the Children Treated with Intralesional Curettage and Bone Grafting: Outcomes and Risk Factors for Local Recurrence

Abstract

Objective: To review the outcomes of surgical management in the pediatric patients with extremity chondroblastoma. Especially the risk factors of recurrence and growth disorder. And discuss a potential method to decrease the rate of growth disorder by preventing the premature physeal closure.

Methods: Fifteen girls and twenty-seven boys aged from two to 14 years (mean, 11 years) with histologically proven chondroblastoma, who presented from January 2011 to June 2018 at our Hospital, were retrospectively reviewed. Clinical data, radiographic images, histological findings, treatment, functional outcomes, and local recurrence rate were analyzed. Surgical treatment included complete curettage of the tumor and the walls of the lesion followed by bone grafting, No adjuvant methods were used. Recurrence was defined as a return of symptoms and an expansion radiolucency at the operated site. It was confirmed by the histopathological analysis. When recurrence was diagnosed, the medical data were analyzed to detect the effect of different factors on local recurrence. Functional outcome was measured according to Sailhan's functional criteria, designed to provide a standardized method of assessing pediatric chondroblastoma patient postoperatively.

Results: The proximal part of the femur was the most frequently involved site. All the patients had at least 24 months of follow-up; mean duration was 30 months (range, 24-60 months). The local recurrence rate was 9.5%. Three resolved after repeat surgeries without further recurrence, one had a second recurrence and received another more aggressive curettage. Local recurrence of chondroblastoma was associated with age (P < 0.05), while not associated with sex, tumor location, the radiological character of the lesion or the grafting method (P > 0.05). No pulmonary metastasis was noted at latest follow-up. Five patients suffered from premature closure of physis due to physis injury. Thirty-one patients (73.8%) had a good outcome, and all returned to normal unrestricted activities. Six patients (14.3%) had a fair outcome due to occasional pain, asymmetric range of motion, or radiographic joint changes without arthritis. And five patients (11.9%) had a poor outcome because of chronic pain, loss of joint motion impairing normal life activities, or a limb-length discrepancy and limp.

Conclusions: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. Being less than 12 years of age was the risk factor for recurrence. For those growing patients, premature physeal closure was observed after the curettage, interpositional technique with PMMA would be a good choice for prevention.

Keywords: Bone grafting; Children; Chondroblastoma; Curettage; Recurrence.

Fig. 1

A recurred case. This patient presented at the age of 11 years with a typical chondroblastoma of the distal femoral epiphysis, clearly shown on X‐ray and MRI (A). This was treated by curettage and bone grafting but recurred 11 months later. The radiograph shows the enlarged cavity and the remained artificial bone in the epiphysis (B). This was treated by another aggressive curettage and bone grafting (C). The final radiograph taken 3 years later at skeletal maturity shows the lesion had completely healed and there does not appear to be any damage to the growth plate (D).

Fig. 2

This patient presented at the age of 10 years with a typical chondroblastoma of the left proximal femoral epiphysis, clearly shown on X‐ray and CT (A). This was treated by curettage and bone grafting. The final radiograph taken 6 years later at skeletal maturity shows the lesion had completely healed and showed short neck compared to the normal side (B, C).

Fig. 3

This 6‐year‐old boy presented with chondroblastoma of the left proximal femoral epiphysis, shown on X‐ray, CT and MRI (A). This was treated by curettage and bone grafting (B). The latest AP view taken 2 years later shows the lesion had completely healed, but with short neck and coxa valgum compared to the normal side (C).

Fig. 4

Chondroblastoma of the proximal tibiaepiphysis in a 12‐year‐old boy before (A), during (B), and 3 years after (C) curettage and defect filling with bone grafting. Latest follow up shows around 10 degrees proximal tibia varus.