Autografts, Allografts and Bone Substitutes in Lytic benign Bone Tumors and Tumour Like Lesions: A Comparative Study of Filling Defects and Healing in 90 Patients

Abstract

Background: Extended curettage is treatment of choice for most benign lesions. To fill the defect after curettage remains a major problem particularly in children and in large cavities. We compared the results of allografts, autografts and bone substitutes in patients with benign bone tumors and tumour like conditions after curettage in view of healing of the lesion and their complications. Material and Methods: Total 90 patients (54 males and36 females) of benign lytic bone tumors in extremities and amenable to curettage were included in this prospective study. Extended curettage was done using the sharp curettes and high-speed burr. The age of patient ranged from 6 years to 62 years. Giant cell tumor 33.3% (n=30) and aneurismal bone cyst 30% (n=27) were the most common type of tumors in our series. There were twelve patients (13.3%) of enchondroma and ten patients each (11% each) of simple bone cyst and chondroblastoma. One patient had chondromyxoid fibroma. Mean tumor volume was 29.88 cm3 (range 2.7 to 168.48). The defects were filled by either autograft, allograft or bone substitutes making the comparative groups. The mean follow up period was 46months (range 24–70). Results: Autografts were used in 32 patients (35.6%) allografts in 28 (31.1%) and in remaining 30 cases (33.3%) bone substitutes were used. Autografts had shortest healing time with mean value of 6.77 ± 3.2 weeks (4–16 weeks) followed by bone substitutes 10.0± 2.4weeks (8-14 weeks). Allograft demonstrated maximum healing time with mean 11.25 ± 2.6weeks (range 8-16 weeks). Additional scar 100% (n=32), cosmetic deformity 6.25% (n=2), recurrence 6.25%(n=2) and infection 3.13%(n=1) were chief complications in autograft group. Serous discharge was observed in 64.3% (n=18) patients of allograft and in 23.3% (n=7) of bone substitute groups and one patient each in these two groups had infection respectively. There was one recurrence each in allograft and bone substitute groups respectively. Cost was big limiting factor for usage of bone substitutes in large cavities. Functional assessment was done by Musculoskeletal Tumor Society Rating Scale (MSTS) score while radiographic assessment of graft uptake by Irwin grading. The overall average Musculoskeletal Tumor Society (MSTS) score was 26.75 (range 24-30). Conclusion: Autograft is the best material to fill the defect after extended curettage of benign lytic lesions of bone. Bone substitutes and allografts are the options if autograft not available like in children. We observed that in small cavities bone substitutes can be an effective alternative and in large cavities it is better to use either allograft alone or a combination of autograft.