Vol.19 No.2

Original Article

Treatment of juxta-articular intraosseous cystic lesions in rheumatoid arthritis patients with interconnected porous calcium hydroxyapatite ceramic

Authors

Kohji Kuriyama1 , Jun Hashimoto2 , Tsuyoshi Murase2 , Masakazu Fujii3 , Akihide Nampei2 , Makoto Hirao2 , Hideki Tsuboi4 , Akira Myoui2 , Hideki Yoshikawa2

  • Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
  • Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
  • Department of Orthopaedic Surgery, Gratia Hospital, Minoh, Japan
  • Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
Received:

16 June 2008

Accepted:

18 November 2008

Published online:

27 January 2009

Full Text

PDF　(member's only)

Abstract

In patients with rheumatoid arthritis (RA), juxta-articular intraosseous cystic lesions may cause spontaneous pathological fractures. The outcome of curettage and the packing of such lesions with interconnected porous calcium hydroxyapatite ceramic (IP-CHA) was investigated. Twelve lesions were treated in ten RA patients (three men and seven women with a mean age of 59 years). Ten lesions were associated with impending pathological fracture involving the articular surface. In all patients, curettage and packing of the bone cavity with IP-CHA were done. Assessment was based on final radiographs obtained an average of 30 months after surgery (range 10-47 months). Absorption of the implanted IP-CHA, expansion of the lesion, implant incorporation into host bone, and postoperative fractures were investigated. At final follow-up, there was no absorption of the implanted IP-CHA in any of the lesions. Expansion of the radiolucent area was only noted in one lesion. Seven of the other 11 lesions showed major incorporation of IP-CHA into host bone, while minor incorporation was seen in four lesions. There were no postoperative fractures. In conclusion, curettage and packing with IP-CHA is a feasible method of preventing pathological fracture due to juxta-articular intraosseous cystic lesions in RA patients.
Electronic supplementary material The online version of this article (doi:10.1007/s10165-008-0147-8) contains supplementary material, which is available to authorized users.

Key words

Interconnected porous calcium hydroxyapatite ceramic - Juxta-articular intraosseous cystic lesions - Rheumatoid arthritis - Surgical treatment