Amit Lakkaraju MBBS, FRCR, Presenter: Nothing to Disclose

Rob Campbell MBCHB, Abstract Co-Author: Nothing to Disclose

Andrew James Dunn MBBCh, Abstract Co-Author: Nothing to Disclose

Benign cystic bone lesions of the lower limb such as UBC, ABC, cystic degeneration of benign lesions or intraosseous ganglion cysts, may present with pain or mechanical symptoms. This case series describes our initial experience of image guided osteoplasty of these lesions using an osteo-conductive calcium pyrophosphate bone graft substitute (Pro-Dense™) along with radiological and clinical outcomes.

Our study included all patients below 30yr of age with a painful benign cystic bone lesion referred to a tertiary orthopaedic oncology centre due to their high bone remodelling potential. The patients filled out a pre and post-procedure Visual Analogue Scale (VAS) pain score. Radiological work up was with plain films, MRI and CT for diagnosis, exclude pathological fractures and confirm suitability for safe percutaneous intra-lesional needle placement. The procedure was performed under a general anaesthetic using fluoroscopy or CT to guide needle placement. An afferent 10G introducer needle was used to inject the bone substitute. An 11G efferent needle was sited dependently to allow fluid decompression of the cyst. An Amplatz superstiff wire was then used to produce bleeding in the cyst lining.  Complete filling of the cavity was the desired end point. The patient had an interval CT scan at 6 weeks and 6 months to assess osseous integration and clinic review to assess efficacy of treatment.

6 lesions (4 proximal femur, 1 calcaneal, 1 navicular) were treated in 6 patients ( mean age 26y, range 19-31y). All patients were discharged on the day of the procedure without complications. They were mobile after an average of 4 hours. Five patients had 6-week follow-up and reported improvement in VAS scores (mean drop in VAS score of 5, range 3-9). Of the 5 cases that had follow-up, all demonstrated osseous integration of bone substitute on imaging. At the time of writing one patient was yet to have the 6-week follow up appointment.

Percutaneous osteoplasty using bone substitute appears to be a promising method of treatment for painful benign cystic bony lesions. Our preliminary results show larger lesions with fewer locules have better results in both clinical and imaging outcome measures. 

This new technique shows promising results in the radiological treatment of benign cystic bone lesions in a young patient group with quick rehabilitation compared to surgery.

Lakkaraju, A, Campbell, R, Dunn, A, Osteoplasty of Benign Cystic Boney Lesions: Initial Experience.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009820.html