Ashish V Batra¹*, Dev Rajan Agarwal², Sabneet Singh³, RN Laddha⁴, Navdeep Singh Charan² and Rahul Tripathi²

¹Assistant Professor, Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, India
²Post Graduate Resident, Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, India
³Senior Resident, Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, India
⁴Professor, Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, India

*Corresponding Author: Ashish V Batra, Assistant Professor, Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, Rajasthan, India.

Received: November 07, 2022; Published: December 12, 2022

Abstract

We treated 11 patients with benign bone tumours by curettage and filling the defect with calcium hydroxyapatite (HA). There were 5 females and 6 males with a mean age of 24 years (8 to 55). The mean follow-up was for 9 months. Postoperative radiological assessment revealed that the implanted HA was well incorporated into the surrounding host bone in all patients. None of patients suffered any fractures in the postoperative period. One patient complained of pain associated with HA in the soft tissues, but this diminished within three months. No patient had local pain at the final follow-up. No recurrence noted in any patients. Follow up radiographs showed formation of much appositional bone. We conclude that HA is an excellent bone-graft substitute in surgery for benign bone tumours.

Keywords: Hydroxyapatite (HA); Benign; Tumour; Curettage; Lesion; Incorporation

References

1. Wu PK., et al. “Freezing nitrogen ethanol composite may be a viable approach for cryotherapy of human giant cell tumor of bone”. Clinical Orthopaedics and Related Research 90 (2017): 1060e4.
2. Martti Hirn., et al. “Bone defects following curettage do not necessarily need augmentation”. Acta Orthopaedica 1 (2009): 4-8.
3. Bini SA., et al. “Giant cell tumor of bone. Curettage and cement reconstruction”. Clinical Orthopaedics and Related Research (1995): 245e50.
4. Glancy GL., et al. “Autograft versus allograft for benign lesions in children”. Clinical Orthopaedics and Related Research (1991): 28e33.
5. Dion N and Sim FH. “The use of allografts in musculoskeletal oncology”. Instructional Course Lectures 51 (2002): 499e506.
6. Lerner T., et al. “A level-1 pilot study to evaluate of ultraporous beta-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis”. European Spine Journal 18 (2009): 170e9.
7. Moenning JE and Wolford LM. “Coralline porous hydroxyapatite as a bone graft substitute in orthognathic surgery: 24-month follow-up results”. The International Journal of Adult Orthodontics and Orthognathic Surgery 4 (1989): 105e17.
8. Pelker RR and Friedlaender GE. “Biomechanical aspects of bone autografts and allografts”. Orthopedic Clinics of North America 18 (1987): 235e9.
9. Botez P. “Modern surgical treatment of aneurysmal bone cyst using a synthetic bone substitute (Ceraform, a calcium phosphate ceramic)]”. Revista Medico-Chirurgicala a Societatii de Medici si Naturalisti din Iasi 107 (2003): 913e20.
10. Grimes JS., et al. “Collagen and biphasic calcium phosphate bone graft in large osseous defects”. Orthopedics 29 (2006): 145e8.
11. Kadhim M., et al. “Treatment of unicameral bone cyst: systematic review and meta analysis”. Journal of Children's Orthopaedics 8 (2014): 171e91.
12. Mankin HJ., et al. “The use of frozen cadaveric allografts in the management of patients with bone tumors of the extremities”. Orthopedic Clinics of North America 18 (1987): 275e89.
13. Theologis AA., et al. “Spinal Deformity Study G. Type of bone graft or substitute does not affect outcome of spine fusion with instrumentation for adolescent idiopathic scoliosis”. Spine (Phila Pa 1976) 40 (2015): 1345e51.
14. Uchida A., et al. “The use of ceramics for bone replacement: a comparative study of three different porous ceramics”. The Journal of Bone and Joint Surgery. British 66-B (1984): 269-275.
15. Holmes RE., et al. “Porous hydroxyapatite as a bone graft substitute in diaphyseal defects: a histometric study”. Journal of Orthopaedic Research 5 (1987): 114-121.
16. Holmes R., et al. “A coralline hydroxyapatite bone graft substitute: preliminary report”. Clinical Orthopaedics 188 (1984): 252-262.
17. Shimizu T., et al. “Bone ingrowth into porous calcium phosphate ceramics: influence of pulsing electromagnetic field”. Journal of Orthopaedic Research 6 (1988): 248-258.
18. Takaoka T., et al. “Histological and biochemical evaluation of osteogenic response in porous hydroxyapatite coated alumina ceramics”. Biomaterials 17 (1996): 1499-1505.
19. Sempuku T., et al. “Osteogenic potential of allogeneic rat marrow cells in porous hydroxyapatite ceramics: a histological study”. Journal of Orthopaedic Research 14 (1996): 907-913.
20. Buma P., et al. “Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat”. Biomaterials 18 (1997): 1251-1260.
21. Suominen EA., et al. “Hydroxyapatiteglass composite as a bone substitute in large metaphyseal cavities in rabbits”. International Orthopaedics 19 (1995): 167-173.
22. Overgaard S., et al. “Hydroxyapatite and fluorapatite coatings for fixation of weight loaded implants”. Clinical Orthopaedics 336 (1997): 286-296.
23. Takahashi T., et al. “Use of porous hydroxyapatite graft containing recombinant human bone morphogenetic protein-2 for cervical fusion in a caprine model”. Journal of Neurosurgery 90 (1999): 224-30.
24. Sun JS., et al. “The influence of hydroxyapatite particles on osteoclast cell activities”. Journal of Biomedical Materials Research 45 (1999): 311-321.
25. Wilke A., et al. “Biocompatibility analysis of different biomaterials in human bone marrow cell cultures”. Journal of Biomedical Materials Research 40 (1998): 301-306.
26. Vuola J., et al. “Compressive strength of calcium carbonate and hydroxyapatite implants after bonemarrow-induced osteogenesis”. Biomaterials 19 (1998): 223-227.
27. Hamson KR., et al. “Preliminary experience with a novel model assessing in vivo mechanical strength of bone grafts and substitute materials”. Calcified Tissue International 57 (1995): 64-68.
28. Piecuch JF., et al. “Compressive strength of implanted porous replamineform hydroxyapatite”. Journal of Biomedical Materials Research 18 (1984): 39-45.
29. D’Lima DD., et al. “Omnifit-HA stem in total hip arthroplasty: a 2- to 5-year follow-up”. Clinical Orthopaedics 363 (1999): 163-169.
30. Tonino AJ., et al. “Hydroxyapatite-coated femoral stems: histology and histomorphometry around five components retrieved at postmortem”. The Journal of Bone and Joint Surgery. British 81-B (1999): 148-154.
31. Regner L., et al. “Ceramic coating improves tibial component fixation in total knee arthroplasty”. The Journal of Arthroplasty 13 (1998): 882-889.
32. Uchida A., et al. “The use of calcium hydroxyapatite ceramic in bone tumour surgery”. The Journal of Bone and Joint Surgery. British 72-B (1990): 298-302.
33. Uchida A., et al. “Slow release of anticancer drugs from porous calcium hydroxyapatite ceramic”. Journal of Orthopaedic Research 10 (1992): 440-445
34. Cho HS., et al. “Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series”. BMC Musculoskeletal Disorders 13 (2012): 134.
35. Kaczmarczyk J., et al. “Complete twelve-month bone remodeling with a bi-phasic injectable bone substitute in benign bone tumors: a prospective pilot study”. BMC Musculoskeletal Disorders 16 (2015): 369.
36. Oppenheim W and Galleno H. “Operative treatment versus steroid injection in the management of unicameral bone cysts”. Journal of Pediatric Orthopaedics 4 (1984): 1e7.
37. Scaglietti O., et al. “Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions”. Clinical Orthopaedics and Related Research (1982): 33e42.
38. Sung AD., et al. “Unicameral bone cyst: a retrospective study of three surgical treatments”. Clinical Orthopaedics and Related Research 466 (2008): 2519e26.
39. Shih HN., et al. “Reconstructing humerus defects after tumor resection using an intramedullary cortical allograft strut”. Chang Gung Medical Journal 25 (2002): 656e63.
40. Campanacci M., et al. “Unicameral and aneurysmal bone cysts”. Clinical Orthopaedics and Related Research 204 (1986): 25e36.
41. Lerner T., et al. “A level-1 pilot study to evaluate of ultraporous beta-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis”. European Spine Journal 18 (2009): 170e9.
42. Aboulafia AJ., et al. “Begnign bone tumors of childhood”. Journal of the American Academy of Orthopaedic Surgeons 7 (1999): 377e88.
43. Copley L and Dormans JP. “Benign pediatric bone tumors. Evaluation and treatment”. Pediatric Clinics of North America 43 (1996): 949e66.
44. Gibbs Jr CP., et al. “Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr”. Journal of Bone and Joint Surgery America 81 (1999): 1671e8.
45. Sartoris DJ., et al. “Coralline hydroxyapatite bone graft substitutes: preliminary report of radiographic evaluation”. Radiology 159 (1986): 133-137.

Citation

Citation: Ashish V Batra., et al. “Use of Hydroxyapatite Crystals to Fill the Curetted Bone Cavity in Benign Bone Tumours - A Case Series”.Acta Scientific Orthopaedics 6.1 (2023): 89-94.

Copyright

Copyright: © 2023 Ashish V Batra., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.