The effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases

Abstract

Objectives: This study aims to investigate the effect of adjuvant cryotherapy added to well-performed high-speed burr curettage on the long-term surgical outcomes of chondroblastoma cases.

Patients and methods: Between January 2004 and December 2020, a total of 30 chondroblastoma cases (19 males, 11 females; median age: 18.6 years; range, 9 to 53 years) who were surgically treated were retrospectively analyzed. The pressurized-spray technique was performed using liquid nitrogen. Data including age, sex, radiological appearance, treatment modality, duration of follow-up, skin problems, and recurrence were recorded. All patients received adjuvant liquid nitrogen cryotherapy after extended intralesional curettage with high-speed burr. The bone cavity was filled with an autologous iliac crest bone graft, allograft, or polymethylmethacrylate (PMMA).

Results: The median follow-up was 54 (range, 19 to 120) months. The lesion was located around the knee in 16 (53.3%), in the shoulder in seven (23.3%), around the hip in five (16.6%), and in the ankle in two (6.6%) cases. The defect was filled with an autologous iliac crest bone graft in 28 (93.3%), an additional allograft in eight (26.7%), and PMMA in two (6.7%) cases. Local recurrence was observed in only two (6.7%) patients during follow-up. Two (6.7%) patients developed physeal growth arrest. Osteoarthritic changes were observed in two (6.7%) patients (one knee and one hip) due to the periarticular location of the tumor. Three (10%) patients had skin complications. None of the cases had a pathological fracture.

Conclusion: A well-performed extended intralesional curettage with high-speed burr is the first and essential step in treating chondroblastoma. Adding adjuvant liquid nitrogen cryotherapy with high-speed burr can improve treatment outcomes and significantly reduce the recurrence rate of this disease.

Figure 1. Pressurized spray technique followed by bone grafting and fixation. (a) The lesions were treated first by meticulous, extensive intralesional curettage to remove all the visualized tumoral tissues through an oval window in the cortex, (b) High-speed burr drilling, (c) The application of liquid nitrogen with a pressurized spraying technique, (d) The defects were filled with autogenous cancellous bone graft, (e) Liquid nitrogen was likewise used for the bony window, (f) Fixation of the bone window at the end of the procedure. All figures are taken from the patient archive of Prof. Nevzat DABAK, MD with permission.

Figure 2. An 18-year-old male patient with a chondroblastoma around the left acetabulum, preoperative X-ray (a), coronal and axial sections of MRI (d-e). Following extensive curettage and cryotherapy, the defect was filled with autologous bone grafting with the same procedure. The early postoperative X-ray (b) and the X-ray at nine years (108 months) of follow-up (c). During the follow-up period, no complications developed, such as local recurrence, only a slight degeneration on the roof of the acetabulum. All figures are taken from the patient archive of Prof. Nevzat DABAK, MD with permission.