Abstract
Background
Treatment of aggressive benign bone lesions with curettage, burring, cementation and plate augmentation is a widely accepted treatment. We have used the above method using a locked plate (rather than conventional), facilitating stability and early mobilisation. We hypothesise that this is an alternative to megaprosthetic joint replacement, and provides acceptable functional outcomes at follow-up.
Methods
Patients with peri-articular aggressive benign bone lesions of the lower limb were treated with marginal excision, intra-lesional curettage, burring and cementation. This was augmented with a locked plate of varying designs. Where feasible, liquid nitrogen was used as an adjunctive treatment. Functional outcome was evaluated at follow-up using the Musculoskeletal Tumour Society Score (MSTS). Routine X-rays were performed at follow up to determine if there was any radiographic evidence of recurrence or any complications.
Results
13 patients with aggressive benign tumours of the lower limb were treated between 2005 and 2009. All tumours were aggressive benign peri-articular tumours with extension to the articular surface. Several of the tumours had fractured the articular cartilage and extended into the joint. Several pathological fractures were noted. The patients were treated in the manner described. The average MSTS score was 89%. Average follow-up time is 35 months. Patients were discharged 2 weeks post-operatively, a prerequisite being the ability to achieve 90° of knee flexion. To date there have been no complications or evidence of radiological recurrence.
Conclusion
Our early results in a small series make us cautiously optimistic that this may be an alternative to immediate megaprosthetic reconstruction in patients with relative joint preservation and form an intermediate step in the treatment of aggressive benign peri-articular bone tumours. These may be amenable to arthroplastic reconstruction at a later stage, if necessary.
