Imaging Findings and Complications after Curettage of Atypical Cartilaginous Tumors of Long Bones: A Retrospective Cohort Study

Purpose or Learning Objective: Atypical cartilaginous tumors (ACTs) are slow-growing neoplasms with locally aggressive behavior but low metastatic risk. Treatment approaches vary from conservative management with a wait-and-see strategy to intralesional surgery involving curettage combined with adjuvant therapies such as electrocauterization, phenolization, and ethanol irrigation. This study assessed the imaging characteristics and complications associated with atypical cartilaginous tumors of long bones treated with curettage, adjuvant therapy, and subsequent filling with either cement or bone graft.

Methods or Background: This retrospective study included patients with atypical cartilaginous tumors of long bones who underwent treatment between 2009 and 2022. Treatment consisted of curettage, adjuvant therapy, and bone grafting or cementation. Inclusion criteria were a confirmed atypical cartilaginous tumor diagnosis based on postsurgical pathology and a minimum of 2 years of follow-up with clinical and imaging evaluations. All imaging studies (radiographs, computed tomography, magnetic resonance imaging) were reviewed by three independent readers who assessed complications such as perioperative and postoperative fractures, graft/cement fragmentation, hardware loosening, incomplete graft incorporation, osteonecrosis, and residual disease or local recurrence. Tumor size was measured on preoperative magnetic resonance imaging/computed tomography.

Results or Findings: A total of 68 patients (23 men, 45 women; median age: 53 years) with atypical cartilaginous tumors of long bones were included. The median tumor diameter was 35 mm. All lesions were managed with curettage, adjuvant therapy, and either bone grafting (77.9%) or cementation (22.1%). Prophylactic internal fixation was performed in 92.7% of cases. The median follow-up was 42 months. Normal posttreatment imaging findings were observed in 66.2% of patients. Complications were perioperative fractures (2.9%), postoperative fractures (8.8%), bone graft fragmentation (2.9%), and hardware rupture (1.6%). Cement loosening occurred in 26.7% of cases treated with cementation; incomplete graft integration was noted in 24.5% of patients treated with a bone graft. Hardware loosening was observed in 6.3% of cases with internal fixation. Osteonecrosis of the host bone and residual disease were each reported in 1.5% of patients. Interreader reliability for imaging assessments ranged from moderate to excellent.

Conclusion: Curettage combined with adjuvant therapy is an effective treatment for atypical cartilaginous tumors but associated with a nonnegligible complication rate. Given the indolent nature of atypical cartilaginous tumors and their low potential for malignant transformation, conservative management with active surveillance could be a viable alternative to minimize posttreatment complications.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 June 2025