Benign Bone Tumors and Tumor-Like Bone Lesions: Treatment Update and New Trends

Abstract

The treatment of benign bone tumors (BBT) and tumor-like bone lesions (TBL) has observed the introduction of new drugs, such as intravenous bisphosphonates, which have ossified bone lesions caused by fibrous dysplasia. Aneurismal bone cyst has been treated with sclerosing agents by percutaneous injection, yielding good results. Adjuvants allow joint salvage, maintenance of movements and function, with low rates of recurrence. Among them, the most used ones are bone cement (PMMA), phenol, nitrogen-based cryotherapy, hydrogen peroxide, ethanol and radiotherapy. New methods of treatment include thermal ablation with radiofrequency and laser, mainly utilized for treating osteoid osteoma. Arthroscopy allows resection of benign intra-joint lesions and assists the surgery of subchondral tumors. A great advance is the utilization of synthetic bone substitutes, which are a mixture of osteoinductive growth factors and osteoconductive ceramics, and have presented comparable results to autogenous bone grafts. There is a recent trend for closed treatments, with percutaneous injection of demineralized bone matrix (DBM) and calcium sulfate. Autogenous cancellous bone graft remains as the gold standard. Vascularized fibula graft, on the other hand, incorporates faster in the treatment of large destructive lesions. Also, allogenic cortical support allows structural augmentation for aggressive tumors. Freeze-dried allografts are used to fill contained defects and as expanders of autografts. Joint endoprosthesis may be used in large destructive lesions of the distal femur, hip and shoulder.

Finite Element Analysis Could Predict and Prevent a Pathological Femoral Shaft Fracture after En Bloc Resection of a Large Osteoid Osteoma

“…Subsequently, the lateral cortex was drilled completely, while the medial cortex was partially drilled to remove the tumor using a 12-mm cannulated cutter (approximately 15% of the circumference, presented in Figure 3 B,C). Based on previous reports [ 14 , 15 ], after the completion of en bloc bone resection, including the bone tumor, an artificial bone graft (β-tricalcium phosphate block, 10 mm × 20 mm × 10 mm, superpore standard-type: Pentax New Ceramics Division, Hoya Corporation, Tokyo, Japan) was performed for the bone defect ( Figure 3 D,E).…”

Clinical outcome of porous hydroxyapatite/collagen graft on bone defects following curettage of bone tumors

“…Benign bone tumors and tumor‐like bone lesions are often operated upon by intralesional curettage 1 . After the curettage, the bone defect is usually refilled by artificial bone graft substitutes, allograft bone, or autograft bone for restoration of the bone strength 2,3 .…”

Use of cement combined grafting in upper and lower extremity benign bone tumors

“…Resorption of graft material and transmission of disease are associated risks of allograft use. [ 1 ] Polymethylmethacrylate cement is non-biological and its Young’s modulus of elasticity is lower than cortical bone, responds to compression-distraction forces differently compared with cortical bone, and has poor tensile and shear strength. [ 2 ] Demineralized bone matrix is expensive and osteoinductive without structural support.…”