Low rate of healing and high incidence of complications in benign pediatric bone tumors treated with synthetic calcium sulfate-calcium phosphate bone graft.

Abstract

Background: Synthetic calcium sulfate-calcium phosphate bioceramic composite has been developed as a material for bone grafting; however, the literature is limited on outcomes of benign bone tumors treated with bone grafting. This study aims to investigate the outcomes of benign pediatric bone tumors treated with a calcium sulfate-calcium phosphate composite bone graft.

Methods: A retrospective review at a tertiary pediatric hospital with benign bone tumors treated with curettage and bone grafting with a calcium sulfate-calcium phosphate synthetic bone graft from 2008-2018 was included. Minimum follow-up was 6 months.

Results: Twenty-seven patients met inclusion criteria with a mean age of 10.3 ± 4.5 years and follow-up was 37.2 ± 22.3 months. Diagnoses were unicameral bone cysts (n = 16) and aneurysmal bone cysts (n = 11). Pathologic fracture was present in 48% (13/27) of patients on admission. All patients were treated using synthetic bone grafts and 37% (10/27) with internal fixation. Following index treatment, 96% (26/27) had resolution of pain and returned to full activity at 13.4 ± 10.7 weeks. Complications occurred in 33% (9/27) of patients; one developed chronic hip pain resulting in decreased physical activity, seven had a tumor recurrence without fracture, and one had tumor recurrence with pathologic fracture. Revision surgery was required in 26% (7/27) of cases. Per the modified Neer outcomes rating system, 52% of patients had a healed bone lesion, 4% had a healing lesion with a bone defect, and 44% had a persistent/recurrent cyst.

Conclusions: Children with benign bone tumors treated with curettage and bone grafting using a calcium sulfate-calcium phosphate composite had a high incidence of complications and revision surgery.

Level of evidence: IV.