Bone Graft Vs Bone Substitutes in Treatment of Cavitary Benign Bone Tumors (A Systematic Review Study)

Abstract

Abstract Background and Introduction Extended curettage is the commonest mode of treatment of cavitary benign bone tumors. If a tumor is very large and threatening to involve the joint, complete excision with joint reconstruction may be necessary. Cure rates of 90–95% have been achieved using curettage as the sole mode of treatment in benign bony lesions. However this treatment is not devoid of controversy and many authors recommend that bone defect after curettage of benign bone tumors should be filled with bone grafts or bone substitutes. Aim of the Work To compare clinical and radiological outcomes, when possible after using of synthetic bone substitutes and bone grafts in surgical treatment of cavitary benign bone tumors. Materials and Methods This systematic literature review has included 22 studies and consisting of 4 steps which are a systematic search of the literature (PubMed, SCOPUS, Cochrane Library), selection of studies , recording of study characteristics and extraction of data based on clinical outcomes and their comparisons between different surgical groups. Results This systematic review has included 1071 patients of which 742 were treated using different types of bone substitutes, while the remaining 329 were treated using bone grafts (allografts or autografts). Comparing between both groups we have found that the difference in the graft incorporation time between both groups was statistically insignificant which was 6.65 months in group A and 7.01 months in group B with P value = 0.355(NS). The difference in the postoperative fracture rate as well was statistically insignificant; 1.9% in group A and 3.9% in group B with P value = 0.294(NS). However, there was a significant difference in the postoperative infection rate between group A (2.1%) and group B (12.8%) with P value = 0.01(S) and in the recurrence rate as well, which was 10% for group A and 4.3% for group B with P value = 0.002(HS). Conclusion Synthetic bone graft substitutes have evolved in response to the downsides of autograft and allograft. No level I studies regarding their use in the treatment of bone tumors have been performed. This study indicates that all of the bone substitutes are safe and may be as effective as other bone graft options and with no limitation in their source for filling the large defects. Prospective randomized clinical trials in the treatment of bone tumors comparing bone graft substitutes versus other grafts (autograft and allograft) are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft’s efficacy in this regard.