Radiologic evaluation of bone incorporation of strut allografting in bone defects after curettage of benign bone tumors

Large osseous defects have long been a challenge to the reconstructive surgeon. In a series of 104 patients (average age of 26 years; range, 11-60 years) with space occupying lesions of the long bone, we implanted deep-frozen (-70°C) cortical strut allografts into the defects after intralesional curettage. Because of the relatively few published reports on the radiographic appearance of the postoperative course of bone grafting healing, this study was done to investigate the course of radiographic change. This series included 36 fibrous dysplasias, 29 unicameral bone cysts, 22 giant cell tumors, 12 aneurysmal bone cysts, 3 benign fibrous histiocytomas and 2 ossifying fibromas. Fifty-six patients had pathologic fractures. The mean volume of the defect after curettage was 210 ml (range, 56-460 ml). All the patients were followed up for an average of 4 years (range, 2-6 years). At follow-up, good or excellent functional results were found in 97% of the patients (101/104). The radiographs demonstrated complete incorporation of the allogeneic implant and new bone formation in the cavity in 83% of the patients (86/104) (using a semiquantitative method). All pathologic fractures healed. There was no local recurrence or fracture of the cortical graft. There were no other serious complications except for one avascular necrosis of the femoral head. The process of allograft incorporation was similar to that of fresh autograft, though remodeling was rather delayed.