Early Clinical and Radiological Experience with a Ceramic Bone Graft Substitute in the Treatment of Benign and Borderline Bone Lesions

Abstract

Substitutes for bone grafts experience increasing popularity, but the need for defect-filling following simple curettage of benign bone lesions is controversial. In this study, we wish to objectively report the radiological changes following bone defect-filling using a composite ceramic bone graft substitute, as well as the clinical results and complications. We evaluated 35 surgically treated benign bone lesions with subsequent defect-filling using two variants of a composite ceramic bone graft substitute (CERAMENT|BONE VOID FILLER or CERAMENT|G, BONESUPPORT AB, SWEDEN). After one year, a normal cortical thickness surrounding the defect was seen in approximately 80% of patients. Inside the defect-cavity, an almost complete product-resorption was seen after one year. The most common complication was a post-operative inflammatory soft-tissue reaction, seen in 7 patients (20%), which resolved without further treatment, although short-term antibiotic treatment was initiated at a local hospital in 6 patients, due to suspected wound infection. In summary, cortical thickness most commonly normalizes after bone tumor removal and filling of the bone defect using this particular composite ceramic bone graft substitute. The ceramic substitute undergoes resorption, which causes progressive changes in the radiological appearance inside the bone defect.

Radiographic and clinical assessment of unidirectional porous hydroxyapatite to treat benign bone tumors

“…In the present study, all preoperative pathological fractures were healed within 3 months after tumor resection followed by UDPHAp implantation, and 84% of cortical thinning around the tumor was regenerated at a mean of 10 months postoperatively. Horstmann et al 1 reported similar cortical bone thickness results using a composite ceramic bone graft substitute. There have been few other studies on postoperative radiographic change in cortical thinning due to bone tumors.…”

“…Tumor resection often results in more severe cortical bone thinning. Horstmann et al 1 studied postoperative changes of cortical thinning in the treatment of benign bone tumors, and reported that cortical thickness normalized in 80% of cases one year after tumor resection and filling with bone substitutes. It is important to fill the cavity left after intralesional resection to restore mechanical strength, although it depends on the size of the defect, the anatomical location, and the functional demands and expectations of the patient.…”

Test yourself answer: supra-acetabular pelvis synthetic bone graft substitute (CERAMENT) with expected resorption of radiopaque graft material

“…Horstmann et al reported an 11% (4 of 35 cases) risk of benign rumor recurrence within 16 months. However, they reported that the rate of product resorption did not influence the indication for reoperation [3].…”

“…Iundusi et al reported graft material resorption within 3-8 months in a series of 24 tibial plateau fractures in which CERAMENT was utilized [5]. Horstmann et al reported near complete graft material resorption after 1 year when CERAMENT was used in the treatment of benign and borderline bone lesions [3]. Likewise Kaczmarczyk et al reported complete graft material resorption within 12 months in 13 out of 14 benign bone tumors in which CERAMENT was utilized in management [9].…”

“…Likewise Kaczmarczyk et al reported complete graft material resorption within 12 months in 13 out of 14 benign bone tumors in which CERAMENT was utilized in management [9]. Leakage of radiographically visible CERAMENT into surrounding soft tissues is possible and has been reported to resorb within 3-6 months [3]. Bone remodeling at the graft site is not always uniform, especially in patients in whom CERAMENT with an added antibiotic agent was utilized for the management of osteomyelitis [10].…”