Treatment Of Chondroblastoma Research Articles

Chondroblastoma of the femoral head-surgical management, outcomes and clinical perspectives: a case report

Chondroblastoma is a rare benign tumor predominantly affecting the epiphyses of long bones, often presenting in the second decade of life. It is known for its potential to recur and cause joint complications despite its benign histology. This report details the case of a 12-year-old boy diagnosed with chondroblastoma of the femoral head, who underwent surgical treatment involving curettage and the use of synthetic hydroxyapatite (HA) bone substitutes. The patient presented with groin pain and limping, with imaging studies revealing an osteolytic lesion in the femoral head. A core needle biopsy confirmed the diagnosis. To manage the lesion, an anterolateral approach was used to perform extensive curettage, and the defect was filled with HA blocks. Postoperatively, the patient was managed with gradual weight-bearing and regular follow-ups. At five years, the patient exhibited normal hip function with no evidence of tumor recurrence, collapse of the femoral head, or osteoarthritis. This case demonstrates that the use of synthetic HA as a bone substitute in the treatment of chondroblastoma can effectively preserve joint integrity and function, providing a viable alternative to traditional grafting methods. The approach was successful in maintaining articular congruence and preventing complications, highlighting the potential benefits of synthetic materials in managing subchondral bone lesions.

Clinic, diagnosis and treatment of chondroblastoma in children

It is for the first time that the clinical picture, diagnosis and outcomes of surgical treatment of bone chondroblastoma in children (85 patients, aged 816) are described in native literature. Pathological focus was localized in the epiphysis and metaepiphysis of long bone predominantly. Clinical manifestations were pain syndrome, restriction of movement and development of contracture in the adjacent joint. Typical radiological signs included excentrically located osteolytic locus of destruction with speckled inclusions and clear contour. The locus was separated by sclerosis line and periostal stratums were present in the distance from the locus. CT, MRT and angiographic examination enabled to determine the destructive locus at early stages of its development and to differentiate with other tumors, inflammatory diseases and dystrophic processes. In all cases diagnosis was verified morphologically. All patients underwent surgery. In the majority of cases periarticular subchondral resection with cavity electrocoagulation and alloplasty of the defect was performed. In case of articular cartilage destruction intracapsular marginal or segmental resection followed by allo- or autoplasty of the defect was carried out. Recurrences were observed in 8,2%) of cases. In 8 patients shortening or deformity of limb developed as a result of growth zone damaged caused by pathological process and surgical intervention. Those problems were eliminated by additional surgery.

Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients

BackgroundTo review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population.Materials and methodsA retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months.ResultsA total of 11 patients were included (mean 14 years, age range 9–17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2–L3 transient radiculopathy as major immediate complication.ConclusionsPercutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.

Rare chondroblastoma of the 6th left rib, video-assisted thoracoscopy resected: one case report and literature review

IntroductionChondroblastoma is a rare, benign locally but aggressive bone tumor. It accounts for < 1% of primary bony tumors, and mostly arises from long bones; the rib chondroblastoma is especial rare. Due to its rarity, there are no definitive or standard treatment guidelines.Case presentationA case of a 24-year-old male with a chondroblastoma located on the 6th posterior left rib. Computed tomography (CT) demonstrated a rib tumor that was a well-defined oval lesion of 20 mm × 18 mm, with lytic bone destruction. The imaging first diagnosis was Langerhans cell histiocytosis (LCH), a giant cell tumor, or other type of neoplasm. The whole tumor and a part of partial rib were resected by video-assisted thoracoscopy surgery (VATS). Pathological and immunohistochemical (IHC) examination made a diagnosis of chondroblastoma. Compared with traditional open thoracic surgery, VATS can achieve the same effects and cause less injury to patient. No postoperative adjuvant therapy was given, and had followed up 23 months after surgery, there was no recurrence or metastasis.ConclusionChondroblastoma has a risk of recurrence and metastasis, surgery plays an important role in the treatment of chondroblastoma, VATS can achieve the same outcome as traditional open thoracic surgery with less pain and lung function. Close follow-up is needed postoperative.

Percutaneous Radiofrequency Ablation of Appendicular Skeleton Chondroblastoma—an Experience from a Tertiary Care Cancer Center

PurposeTo evaluate safety and long-term efficacy of radiofrequency (RF) ablation in treatment of chondroblastoma. Materials and MethodsThis retrospective analysis comprised 27 consecutive patients with histopathologically proven chondroblastoma treated by RF ablation. The tumors were located in the proximal humerus (n = 6), proximal tibia (n = 8), proximal femur (n = 6), distal femur (n = 5), acromion process (n = 1), and lunate (n = 1). In 19 patients (70.3%), the tumor was in the weight-bearing area of the bone. Clinical response was assessed by comparing pain scores and functional assessment by Musculoskeletal Tumor Society (MSTS) score before and after ablation. Patients were followed for a minimum of 1 year to rule out complications and recurrence. ResultsTechnical success rate was 100%. Mean pain score before the procedure was 7.34 (range, 7–9); all patients experienced a reduction in pain, with 25 (92.6%) patients reporting complete pain relief at 6 weeks. Mean MSTS score before the procedure was 15.4, whereas mean MSTS score at 6 weeks after the procedure was 28.6, suggesting significant functional improvement (P < .0001). Two patients developed osteonecrosis and collapse of the treated bone. There were no recurrences. ConclusionsPercutaneous RF ablation is a safe and effective option for treating chondroblastoma of the appendicular skeleton.

Functional and Oncological Outcome After Treatment of Chondroblastoma With Intralesional Curettage.

Chondroblastoma is a rare cartilaginous benign bone tumor that commonly arises in long bones of young people. Surgical management is the primary treatment of choice for chondroblastoma and it entails adequate intralesional curettage alone or in combination with adjuvants. This study was performed to describe the epidemiological characteristics and clinical and radiologic results of intralesional curettage of chondroblastoma. This was a retrospective study which included an analysis of 91 patients with chondroblastoma who were treated with intralesional curettage and were followed up between 1994 and 2014 for at least 3 years. Epidemiological data, clinical symptoms, radiologic and histologic investigations, surgery, functional outcomes, complications, and local recurrence rate were analyzed. There were 60 males (65.9%) and 31 females (34.1%) with a mean age of 16.4 years. The most commonly involved bone was the proximal tibia in 24 patients (26.4%), followed by distal femur in 20 patients (22%), proximal humerus in 17 patients (18.7%) and proximal femur in 15 patients (16.6%). All patients underwent intralesional curettage. High-speed burr was used in 66 patients (72.5%). The resultant cavity was filled with autogenous bone graft, bone substitute, bone cement or a combination of bone graft and cement. Four patients (4.4%) had complications. Three patients (3.3%) developed local recurrence. Age, site, history of previous intervention or pathologic fracture had no impact on the rate of recurrence. The mean Musculoskeletal Tumor Society (MSTS) score was 28.88 (range, 24 to 30) points. Thorough curettage using high-speed burr and bone-grafting or bone cement in the treatment of chondroblastoma has good local control, low recurrence rate and excellent functional long-term outcome. Level IV, retrospective case series.

Clinical features, treatments and long-term follow-up outcomes of spinal chondroblastoma: report of 13 clinical cases in a single center.

Chondroblastoma (CB) in the spine is extremely rare and there is little published information regarding this subject. We attempt to explore the clinical features of spinal CB and address the importance of total resection, especially total en bloc spondylectomy (TES) for the treatment of spinal CB. Clinical data of 13 consecutive CB patients who received surgical treatment in our center between January 2006 and December 2016 were reviewed retrospectively. Recurrence-free survival (RFS) was estimated by Kaplan-Meier method and Log-rank test. The 13 CB patients included 9 men and 4 women with a mean age of 32years. The lesions were located in the cervical spine in 2 cases, thoracic spine in 5 cases, and lumbar spine in 6 cases. All the patients were treated surgically using either curettage, piecemeal total resection, or TES. Postoperative radiotherapy was administered in 2 cases. The mean follow-up period was 41.6months. Relapse occurred in 3 (23.1%) cases, resulting in one death in 60months. The mean RFS duration was 28.7months. CB predominantly affects males and various age groups. Spinal CB more commonly involves the thoracic and lumbar segments. Spinal CB usually appears as an aggressive and destructive bony lesion with a soft tissue mass on imaging, forming compression on the spinal cord in some cases. Recurrence is not uncommon for spinal CB. Total resection, especially TES, has been confirmed as a powerful method to control the disease, while curettage is more likely to associate with local recurrence. Radiotherapy does not seem to reduce local recurrence.

Clinical observation of expanded curettage in treatment of chondroblastoma

To explore the effectiveness of expanded curettage in the treatment of chondroblastoma. The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years (range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months (range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in 2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3rd stage. The length of the lesion ranged from 1.2 to 6.9 cm (mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 27.5±1.4, and the difference was significant when compared with pre-operative value (18.5±1.9) ( t=23.462, P=0.000). The chondroblastoma recurred in 1 case (2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected. Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.

Chondroblastome : résultats après curettage intralésionnel

BackgroundChondroblastoma is an uncommon benign bone tumor with an incidence of 1% to 2% among all primary bone tumors. In the past, treatment for chondroblastoma has been highly variable leading to different rates of recurrences. Therefore, we aimed to determine: (1) the rate of recurrence, (2) the complication rate, (3) and functional outcome after intralesional curettage of chondroblastoma. HypothesesIntralesional curettage with high speed burring and packing can avoid local recurrences. Patients and methodsExperiences of 22 patients with chondroblastoma of the bone were retrospectively reviewed. The patient group consisted of 16 men; 6 women; mean age 24years (range; 12–58years) affecting in 15 the lower (68%) and in seven the upper extremity (32%). ResultsThere was no local recurrence or malignant transformation. All patients underwent intralesional curettage followed by defect filling presenting in 19 patients (87%) excellent clinical and oncological results (mean MSTS 98.9). Complications were seen in two patients. Pain was the main revealing symptom of the chondroblastoma (n=16, 73%). Mean follow-up of all patients was 114months (range; 25–480months). DiscussionAggressive curettage and packing provided excellent local tumor control and functional results in our patients with chondroblastoma. Malignant transformation is extremely rare, however, present in literature but was not seen in any of our patients. Level of evidenceLevel IV, retrospective study.

Complete local tumor control after curettage of chondroblastoma–a retrospective analysis

BackgroundChondroblastoma is an uncommon benign bone tumor with an incidence of 1 to 2% among all primary bone tumors. In the past, treatment for chondroblastoma has been highly variable leading to different rates of recurrences. Therefore we aimed to determine: (1) the rate of recurrence, (2) the complication rate, (3) and functional outcome after intralesional curettage of chondroblastoma. HypothesesIntralesional curettage with high speed burring and packing can avoid local recurrences. Patients and methodsExperiences of 22 patients with chondroblastoma of the bone were retrospectively reviewed. The patient group consisted of 16 men; 6 women; mean age 24years (range; 12–58years) affecting in 15 the lower- (68%) and in seven the upper extremity (32%). ResultsThere was no local recurrence or malignant transformation. All patients underwent intralesional curettage, followed by defect filling presenting in 19 patients (87%) excellent clinical and oncological results (mean MSTS 98.9). Complications were seen in two patients. Pain was the main revealing symptom of the chondroblastoma (n=16, 73%). Mean follow-up of all patients was 114months (range, 25 to 480months). DiscussionAggressive curettage and packing provided excellent local tumor control and functional results in our patients with chondroblastoma. Malignant transformation is extremely rare, however, present in literature but was not seen in any of our patients. Level of evidenceLevel IV, retrospective study.

Radiofrequency ablation of chondroblastoma: long-term clinical and imaging outcomes.

To investigate the long-term clinical and imaging outcomes of patients with chondroblastoma treated by radiofrequency ablation (RFA). Retrospective analysis of 25 consecutive patients treated with RFA from September 2006 to December 2013. Patients were reviewed within one month of the procedure, then every 3-6 months, and yearly for up to three years. Serial magnetic resonance imaging (MRI) was performed at follow-up to monitor recovery. Functional outcome was assessed using the Musculoskeletal Tumour Society Score (MSTS). Pre-procedure MRI confirmed osteolytic lesions (size range 1.0-3.3 cm; mean 2.0 cm). Patients reported continued symptomatic improvement at four months review. Serial MRI confirmed progressive resolution of inflammation with fatty consolidation of cavity. 88 % of patients became asymptomatic during the follow up period. Three patients' (12 %) symptoms returned at 16, 22 and 24 months respectively after RFA. MRI and biopsy confirmed recurrence in these patients. Functional assessment using MSTS score had an average score of 97.5 %. Mean follow up for the study group was 49 months. RFA is an effective alternative to surgery in the management of chondroblastoma. We recommend a multi-disciplinary approach and RFA should be considered as a first-line treatment. Long-term follow-up is required for timely detection of recurrences. • RFA is a safe and effective technique in the treatment of chondroblastoma. • Positive outcomes in 88 % patients at mean follow-up period of 49 months. • Local recurrences occurred in 12 % cases. • Long-term follow-up is required for timely detection of recurrences. • RFA should be considered as a first-line treatment for chondroblastoma.

What are the results using the modified trapdoor procedure to treat chondroblastoma of the femoral head?

Treatment of chondroblastoma in the femoral head is challenging owing to the particular location and its aggressive nature. There is little published information to guide the surgeon regarding the appropriate approach to treating a chondroblastoma in this location. We developed a modified trapdoor procedure to address this issue. The primary modification is that the window surface of the femoral head is covered by the ligamentum teres rather than cartilage as in the traditional procedure. We assessed (1) the clinical presentation of chondroblastoma of the femoral head and treatment results with the modified trapdoor procedure in terms of (2) the frequency of local recurrence, (3) complications, and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Between 1999 and 2010, we treated 14 patients for chondroblastoma of the femoral head. All patients received the modified trapdoor procedure. Of those, 13 were available for followup at a minimum of 36months (mean, 66months; range, 36-117months) and one patient was lost to followup. There were nine males and four females, with a mean age of 18years (range, 9-29years). Clinical features were ascertained by chart and radiographic review, and recurrence, complications, and functional outcomes (MSTS score) were recorded from chart review. Patterns of bone destruction were evaluated using the Lodwick classification, which ranges from IA (geographic appearance with sclerotic rim) to III (permeative appearance). The symptoms at diagnosis were pain in nine patients and discomfort in four. The mean duration of symptom was 11months (range, 1-36months). The physis was open in two patients, closing in one, and closed in 10. The patterns of bone destruction were evaluated as Lodwick Class IA in six patients, Lodwick Class IB in five, and Lodwick Class IC in two. At latest followup, no local recurrence was observed. Two patients had postoperative complications. One had avascular necrosis of the femoral head and was treated with prosthesis replacement. The other had asymptomatic heterotopic ossification in the surgical field. The mean MSTS score was 29.6 (range, 28-30). Based on this small series, we believe our modified trapdoor procedure is a safe, effective means of treating a chondroblastoma in the femoral head, but additional clinical evaluation with more patients is necessary to confirm our findings. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?

To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery. Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablation. Twelve patients were diagnosed with chondroblastoma. Out of these, 8 patients (6 male, 2 female, mean age 17 years) with chondroblastoma (mean size 2.7 cm) underwent RF ablation. Multitine expandable electrodes were used in all patients. The number of probe positions needed varied from 1 to 4 and lesions were ablated at 90 °C for 5 min at each probe position. The tumours were successfully treated and all patients became asymptomatic. There were no recurrences. There were 2 patients with knee complications, 1 with minor asymptomatic infraction of the subchondral bone and a second patient with osteonecrosis/chondrolysis. Radiofrequency ablation appears to be a safe and effective alternative to surgical treatment with a low risk of recurrence and complications for most chondroblastomas. RF ablation is probably superior to surgery when chondroblastomas are small (less than 2.5 cm) with an intact bony margin with subchondral bone and in areas of difficult surgical access.

Percutaneous Ablation of Benign Bone Tumors

Percutaneous image-guided ablation has become a standard of practice and one of the primary modalities for treatment of benign bone tumors. Ablation is most commonly used to treat osteoid osteomas but may also be used in the treatment of chondroblastomas, osteoblastomas, and giant cell tumors. Percutaneous image-guided ablation of benign bone tumors carries a high success rate (>90% in case series) and results in decreased morbidity, mortality, and expense compared with traditional surgical methods. The ablation technique most often applied to benign bone lesions is radiofrequency ablation. Because the ablation technique has been extensively applied to osteoid osteomas and because of the uncommon nature of other benign bone tumors, we will primarily focus this discussion on the percutaneous ablation of osteoid osteomas.

Treatment of chondroblastoma

Treatment of chondroblastoma

Treatment of chondroblastoma

Treatment of chondroblastoma

Diagnosis and treatment of chondroblastoma of the femoral head.

Objective To investigate the diagnostic and therapeutic methods of chondroblastoma of the femoral head. Methods The thirteen consecutive patients with chondroblastomas of the femoral head were evaluated between February 1999 and March 2008 retrospectively. There were eight males and 5 females. The mean age was 17.9 years (range, 9-29 years).The mean Harris Score before surgery was 67 (range, 38-78). All patients were evaluated by detailed imaging studies before surgery. Biopsy was performed in three patients. Frozen section histology during surgery was performed in another two patients. All the diagnoses were confirmed by pathological examination. All the patients underwent surgery through Smith-Peterson approach. During the operatin, The tumor tissue was thoroughly curetted via fovea of femoral head. Bone grafting was performed in all patients, including autogenous bone grafts in 7 cases , allografts in 5 cases and the mixture of autogenous and allografts in 1 case. Results All the patients were followed up. The median time was 26 months (range, 6-84 months). There was no local recurrence in this group .No operative complications were found during follow-up. One patient who underwent autogenous bone graft had suffered femoral head necrosis after partial weight bearing 2 months after operation.The further intervention included femoral head resection and total hip arthroplasty 6 months after operation in this patient. The remaining patients presented with good function. The mean Harris Score was 89 (range, 69-98 ) after surgery, 21 points increasing from preoperative scores. The mean healing time was 5.3 months, 6.8 months, and 4 months in patents received autogenous bone grafts, allografts and the mixture of autogenous and allografts, respectvely. Conclusion Chondroblastoma of the femoral head, which is uncommon has its specific clinical and radiological characteristics. The curettage can been carried out via fovea of femoral head followed by bone grafting through anterior Smith-Peterson approach. This procedure proved to be a useful surgical approach for the treatment of chodroblastoma in the epiphysis of the femoral head. Weight bearing must be avoided before bone healing. Hip joint exercise without weight bearing can improve the outcome. Key words: Femur head ; Chondroblastoma ; Femoral head ; Diagnosis ; Treatment outcome ;

Diagnosis and treatment of chondroblastoma: Our experience

The paper presented the results of diagnostics and treatment of patients with diagnosis of chondroblastoma, treated at the Institute of Orthopedic Surgery "Banjica", Belgrade. A total of 30 patients were analyzed, involving the period from 1975-2004. All important data were obtained using the complete medical documentation, physical examination, radiographic findings and available additional diagnostic procedures. The proximal part of tibia, the proximal part of humerus and the distal part of femur were the most common sites of tumor, accounting for 63% of cases. Higher incidence of chondroblastoma was found in male patients, especially in the second decade of life. Pathohistological tumor verification was done in all patients. The patients were then treated by different surgical procedures, both on account of primary lesion and recurrence. Curettage and osteoplasty using the auto- and homograft were carried out in 21 patients, wide resection in nine cases, and amputation was performed in three cases. One patient had radiotherapy due to recurrence of lesion, nevertheless malignant transformation of chondroblastoma occurred in time. Seven patients manifested local recurrence, and one of them even had relapse on two occasions and malignant transformation of chondroblastoma. Malignant lesions were found in three cases (10% of patients); one lesion was diagnosed as primary while other two malignancies were detected only after recurrence, and the treatment was completed by lower leg amputation.

Frequency, presentation and postintervention prognosis of chondroblastoma.

To evaluate the frequency of clinico-radiological presentation and the prognosis after treatment of chondroblastoma. A descriptive, observational study. The study was carried out at the Department of Orthopaedic Surgery, JPMC, Karachi over the period of 16 years, January 1986 to June 2002. Patients in teenage, presenting with signs and symptoms of a primary bone tumours, were included by retrospectively reviewing the tumour registry record. Detailed scrutiny of clinical record was carried out to analyze the clinico-radiological presentation and posttreatment prognosis criteria of healing was symptom-free centripetal and homogeneous ossification. Seven (1.24%) out of 563 primary bone tumour cases were chondroblastoma. The clinico-radiological presentation in the 2 out of 7 (28.57%) cases was classical, 2 simulated osteomyelitis and other 3 as chondromyxoid fibroma, aneurysmal bone cyst and giant cell tumour. Lesions were treated with curettage and bone grafting. One patient (14.28%) developed recurrence within 2 years after curettage and healed after re-curettage and bone grafting. Five out of 7 (71.42%) tumours showed good response and 2 out of 7 (28.57%) showed satisfactory response. Chondroblastoma is very rare benign primary bone tumour with high local recurrence rate. The lesions confined to epiphysis of weight-bearing bone present early with symptoms of mild arthritis. Lesions in non-weight-bearing bones often present late and simulates epiphysio-metaphyseal tumours. Lesions heals with centripetal healing and need more than 2 years follow-up to achieve recurrence-free healing.

Treatment for chondroblastoma

Treatment for chondroblastoma