BACKGROUND AND OBJECTIVES: Curettage is the removal of a tumor from the bone while preserving the surrounding healthy cortical bone, and is associated with higher rates of local recurrence. To lower these rates, curettage should be combined with local adjuvants, although their use is associated with damage to nearby healthy bone. OBJECTIVE: The purpose of this analysis is to determine the effect of local adjuvants on cortical porcine bone by using micro-computed tomography (micro-CT) along with histological and mechanical examination. METHODS: Local adjuvants were applied to porcine specimens under defined conditions. To assess changes in bone mineral density (BMD), a micro-CT scan was used. The pixel gray values of the volume of interest (VOI) were evaluated per specimen and converted to BMD values. The Vickers hardness test was employed to assess bone hardness (HV). The depth of necrosis was measured histologically using hematoxylin and eosin-stained tissue sections. RESULTS: A noticeable change in BMD was observed on the argon beam coagulation (ABC) sample. Comparable hardness values were measured on samples following electrocautery and ABC, and lowering of bone hardness was obtained in the case of liquid nitrogen. Extensive induced depth of necrosis was registered in the specimen treated with liquid nitrogen. CONCLUSION: This study determined the effect of local adjuvants on cortical bone by using micro-CT along with histological and mechanical examination. Phenolization and liquid nitrogen application caused a decrease in bone hardness. The bone density was affected in the range of single-digit percentage values. Liquid nitrogen induced extensive depth of necrosis with a wide variance of values.

1st Department of Orthopaedic Surgery St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

1st Department of Pathology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Solid Mechanics Mechatronics and Biomechanics Faculty of Mechanical Engineering University of Technology Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Laboratory of Tumor Biology Department of Experimental Biology Faculty of Science Masaryk University Brno Czech Republic

Zobrazit více v PubMed

van der Heijden L, Dijkstra PDS, van de Sande MAJ, et al. The clinical approach toward giant cell tumor of bone. PubMed DOI PMC

Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. PubMed DOI

Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. PubMed DOI

Capanna R, Fabbri N, Bettelli G. Curettage of giant cell tumor of bone. The effect of surgical technique and adjuvants on local recurrence rate. PubMed

Farfalli GL, Slullitel PAI, Muscolo LD, Ayerza MA, Aponte-Tinao LA. What happens to the articular surface after curettage for epiphyseal chondroblastoma? A report on functional results, arthritis, and arthroplasty. PubMed DOI PMC

Malawer MM, Bickels J. Use of local adjuvants following intralesional resection of bone tumors. In: Malawer MM, Wittig JC, Bickels J (eds). Operative Techniques in Orthopaedic Surgical Oncology. 3rd ed. Wolters Kluwer Healt. pp. 86–91.

Hara H, Sakai Y, Kawamoto T, et al. Surgical outcomes of metastatic bone tumors in the extremities (Surgical outcomes of bone metastases). PubMed DOI PMC

Smolle MA, Roessl V, Leithner A. Effect of local adjuvants following curettage of benign and intermediate tumours of bone: a systematic review of the literature. PubMed DOI PMC

Zhang S, Zhang J, Wang X. Comparison of tumor curettage and resection for treatment of giant cell tumor of the bone around the knee joint. PubMed DOI PMC

Tuntarattanapong P, Piakong P, Chobpenthai T, Sukanthanak B, Kiatisevi P. Comparing clinical outcomes between extended curettage and wide resection in Enneking stage 3 giant cell tumor of bone. PubMed DOI

He H, Zeng H, Luo W, Liu Y, Zhang C, Liu Q. Surgical treatment options for giant cell tumors of bone around the knee joint: Extended curettage or segmental resection? PubMed DOI PMC

Tsukamoto S, Mavrogenis AF, Tanzi P, et al. Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation. PubMed DOI

Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. PubMed DOI

Asano N, Saito M, Kobayashi E, et al. Preoperative denosumab therapy against giant cell tumor of bone is associated with an increased risk of local recurrence after curettage surgery. PubMed DOI

Errani C, Tsukamoto S, Ciani G, Donati DM. Present day controversies and consensus in curettage for giant cell tumor of bone. PubMed DOI PMC

Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. PubMed DOI PMC

Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ. Does Curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? PubMed DOI

Knochentumoren A. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. PubMed DOI

Dürr H, Maier M, Jansson V, Baur A, Refior H. Phenol as an adjuvant for local control in the treatment ofgiant cell tumour of the bone. PubMed DOI

Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. PubMed DOI

Bickels J, Campanacci DA. Local adjuvant substances following curettage of bone tumors. PubMed DOI

Piccioli A, Ventura A, Maccauro G, Spinelli MS, Del Bravo V, Rosa MA. Local adjuvants in surgical management of bone metastases. PubMed DOI

Capanna R, Sudanese A, Baldini N, Campanacci M. Phenol as an adjuvant in the control of local recurrence of benign neoplasms of bone treated by curettage. PubMed

Aydin M, Basarir K, Armangil M, et al. Thermal necrosis induced by electrocauterization as a local adjuvant therapy in local aggressive bone tumors, what is the safe limit for surgical margins? An experimental study. PubMed DOI

Cummings JE, Smith RA, Heck RK. Argon beam coagulation as adjuvant treatment after curettage of aneurysmal bone cysts: a preliminary study. PubMed DOI PMC

Bickels J, Wittig JC, Kollender Y, et al. Enchondromas of the hand: treatment with curettage and cemented internal fixation. PubMed DOI

van der Heijden L, van der Geest ICM, Schreuder HWB, van de Sande MAJ, Dijkstra PDS. Liquid nitrogen or phenolization for giant cell tumor of bone?: A comparative cohort study of various standard treatments at two tertiary referral centers. PubMed DOI

Bombardier B, Haase D, Sweeney K, Friedman E, Poppe T, Hughes N. A comparison of depth of necrosis among adjuvant therapies used for the treatment of benign bone tumors. PubMed DOI

Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, Peabody TD. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? PubMed DOI

Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor: a long term followup study. PubMed DOI

Chen YC, Wu PK, Chen CF, Chen WM. Intralesional curettage of central low-grade chondrosarcoma: a midterm follow-up study. PubMed DOI

Lin WH, Lan TY, Chen CY, Wu K, Yang RS. Similar local control between phenol- and ethanol-treated giant cell tumors of bone. PubMed DOI PMC

Sekhon K, Kazakia GJ, Burghardt AJ, Hermannsson B, Majumdar S. Accuracy of volumetric bone mineral density measurement in high-resolution peripheral quantitative computed tomography. PubMed DOI PMC

Marcián P, Borák L, Zikmund T, et al. On the limits of finite element models created from (micro)CT datasets and used in studies of bone-implant-related biomechanical problems. PubMed DOI

Wu W, Zhu Y, Chen W, et al. Bone hardness of different anatomical regions of human radius and its impact on the pullout strength of screws. PubMed DOI PMC

Li S, Wang J, Yin B, et al. Atlas of human skeleton hardness obtained using the micro-indentation technique. PubMed DOI PMC

Liu H, Zhu R, Liu C, et al. Evaluation of decalcification techniques for rat femurs using HE and immunohistochemical staining. PubMed DOI PMC

Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon MA. Argon beam coagulation as an adjuvant for local control of giant cell tumor. PubMed DOI

Miller A. Collagen: the organic matrix of bone. PubMed DOI

van der Geest ICM, de Valk MH, de Rooy JWJ, Pruszczynski M, Veth RPH, Schreuder HWB. Oncological and functional results of cryosurgical therapy of enchondromas and chondrosarcomas grade 1. PubMed DOI

Marcove RC. A 17-year review of cryosurgery in the treatment of bone tumors. PubMed DOI

Mittag F, Leichtle C, Kieckbusch I, et al. Cytotoxic effect and tissue penetration of phenol for adjuvant treatment of giant cell tumours. PubMed DOI PMC

Harris LW, Griffiths JB. Relative effects of cooling and warming rates on mammalian cells during the freeze-thaw cycle. PubMed DOI

Mazur P. Freezing of living cells: mechanisms and implications. PubMed DOI

Malawer MM, Marks MR, McChesney D, Piasio M, Gunther SF, Schmookler BM. The effect of cryosurgery and polymethylmethacrylate in dogs with experimental bone defects comparable to tumor defects. PubMed DOI

Heck RK, Pope WD, Ahn JI, Smith RA, Webber BL. Histologic evaluation of the depth of necrosis produced by argon beam coagulation: implications for use as adjuvant treatment of bone tumors. PubMed

Giacomo GD, Ziranu A, Perisano C, Piccioli A, Maccauro G. Local adjuvants in surgical management of bone lesions. DOI

ASO Author Reflections: The Effect of Local Adjuvants on Cortical Bone Following Intralesional Curettage of Bone Tumors