| Abstract: | Objective Extensive excochleation of juxta-articular osteolytic lesions. Temporary filling of the defect with bone cement to preserve joint function, to prevent fracture and recurrence. During the second sitting, the bone cement is removed and replaced preferably by autogenous bone grafts. Indications Juxta-articular osteolytic lesions which are benign or of low malignancy. Lesions of questionable malignancy as well as tumorlike conditions such as giant cell tumors, chondroblastomas, unicameral and aneurysmal bone cysts, which are all characterized by a high tendency of recurrence. Contraindications Malignant bone tumors, lesions invading the overlying soft tissues. Surgical Technique Stage 1: fenestration of bone, complete curettage or excisional biopsy. Filling of the defect with bone cement. Internal fixation if indicated. Stage 2: after freedom from recurrence of at least 1 year, removal of the bone cement and replacement with preferably autogenous bone grafts. Removal of the perifocal soft tissue membrane for histologic examination. In the presence of recurrence, the excochleation is repeated as well as the filling with bone cement. Results Between 1982 and 1999, the described technique was performed in 27 patients (ten men, 17 women, age 9-68 years). A total of 29 cement fillings were done, 23 for primary surgery, six for recurrences. The initial surgery was followed by three recurrences, two of which underwent repeat filling and remained free of recurrence for 24 and 102 months, respectively. A special tumor prothesis was used in one woman for recurrence of a giant cell tumor. The duration of follow-up varied between 1 and 151 months (average 49 months). The joint function was excellent 14 times, good ten times, and poor once. The following complications were encountered: two fractures, one draining sinus, one osteoarthritis, and one axial malalignment. |
