Osteoclastoma of bone: Role of extended curettage with allogenic bone grafting

Abstract

Background: Mesenchymal stromal cells are origin for benign tumor osteoclastoma of bone. Different location of presentations with varied manifestations is a unique feature of osteoclastoma. Extended curettage of the lesion and supplementary allogenic bone grafting in selected cases is widely used treatment regimen. Selection of cases is important for successful outcome using this as a treatment protocol. Our study with 30 cases aims in selection of cases for successful outcome with this treatment protocol. Materials and Methods: Biopsy proven (core and open biopsy) 30 cases of osteoclastoma are selected. The cases are evaluated clinically, radiographically, CT &MRI scan and by histology. Campanancci grading and Enneking staging was used in the study. Chi square tests, Mann Whitney test and ANOVA were used for statistical analysis. Tumors with cortical breach which is confined to one surface and cortical breach less than one third of circumference were managed by extended curettage and bone grafting.Results: The average age of presentation was 25 years. Distal femur is the commonest site (16 cases) followed by upper end of tibia (12 cases) and 2 cases are from distal radius. Pathological fractures were seen in 2 cases. 4 tumors had less than 5 mm of subchondral bone free of tumor. The average follow up period was 18.6 months (range 2-84). 4 cases of recurrence were seen in a grade III recurrent distal femur lesion (3) and proximal tibia group (1) in the intralesional curettage group.Conclusion: Extended curettage with allogenic bone grafting is a reliable method with good functional outcome with less complications than other methods (enbloc excision) whenever we stick on to principles of tumor surgery with proven guidelines of case selection. Recurrence can always be treated with recurettage.