Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications

Abstract

Background: Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage.

Methods: We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur's head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient.

Results: Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed.

Conclusion: More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis.

Trial registration: Retrospectively registered.

Keywords: Aggressive curettage; Chondroblastoma; Epiphysis; Osteoarthritis; Recurrence.

Fig. 1

A 19 year-old patient with giant aggressive distal femoral CBL associated with ABC (A), treated with extraarticular knee resection and allograft-prosthesis composite reconstruction (B, C)

Fig. 2

A 11-year-old girl with an active proximal humerus CBL with involvement of growth plate (A) developed two recurrences after 6 (C) and 12 months (E), both treated with a new aggressive curettage and filling with allogenic bone graft (B, D, F)

Fig. 3

Recurrence free survival at 5 and 10 years

Fig. 4

Recurrence free survival at 5 and 10 years according to age at surgery

Fig. 5

A 27 year-old patient with femoral head CBL (A) treated with intralesional curettage through direct anterior approach and hip dislocation (B) and filling with allogenic graft (C)