The risk for fractures after curettage and cryosurgery around the knee

Tamir Pritsch, Jacob Bickels, Chia Chun Wu, Hart M. Squires, Martin M. Malawer

Research output: Contribution to journalArticlepeer-review


Curettage and cryosurgery have been used successfully for treatment of benign locally aggressive and some low-grade malignant bone tumors. After treating these lesions, we reconstruct residual bone defects around the knee with cement, intramedullary pins, and autogenous bone graft for subchon-dral augmentation and closure of cortical windows. We questioned the incidence of fractures and the rates of nonunion and malunion and asked whether patients at risk for fractures can be identified. We conducted chart and radio-graphic reviews of 60 consecutive patients who had curettage and cryosurgery of primary bone lesions in the distal femur or proximal tibia. Ten of the 60 patients (17%) sustained postoperative intraarticular fractures. Patients who sustained fractures had (1) more freeze-thaw cycles; (2) metaph-yseal defect ratios greater than 0.6 and 0.8 on the anteropos-terior and lateral projections, respectively; and (3) 4 mm or less proximity of the defect to the joint. Only one fracture united in good alignment. Radiographic measurements can assist in identifying patients at risk for fractures after curet-tage and cryosurgery around the knee. We expect the fracture rate to decline by reducing the number of freeze-thaw cycles and improving our reconstruction method. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)159-167
Number of pages9
JournalClinical Orthopaedics and Related Research
StatePublished - May 2007
Externally publishedYes


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