Imaging findings and complications after curettage of atypical cartilaginous tumors in long bones: a retrospective single-center cohort study

Objective: To assess imaging findings and complications after curettage of atypical cartilaginous tumors (ACTs) in long bones. Materials and methods: This retrospective study included patients with central ACTs of long bones treated with curettage, adjuvants, and cementation or bone grafting, who had clinical and imaging follow-up data available for at least 2 years after surgery. All imaging studies (radiographs, CT, MRI) were independently assessed by three radiologists. Clinical information was collected from the medical records. Results: Sixty-eight patients were included (median age [interquartile range, IQR], 53 [45-60] years). Bone graft and cement were used in 53 (77.9%) and 15 (22.1%) patients, respectively. Prophylactic internal fixation was performed in 63 (92.7%) patients. The median (IQR) follow-up duration was 42 (30-64) months. Normal imaging findings were identified at follow-up in 45 patients (66.2%). Our reported complications included peri- (2.9%) and post-operative (8.8%) bone fractures, incomplete bone graft integration (24.5%, out of patients treated with bone grafting), cement loosening (26.7%, out of patients treated with cementation), fixation hardware rupture (1.6%) or loosening (6.3%, out of patients treated with internal fixation) and residual disease (1.5%). Incomplete bone graft integration and cement loosening were associated with tumor location in the humerus (p = 0.023). Inter-reader agreement ranged between moderate and excellent (Fleiss's K = 0.522-1). Conclusion: After curettage of ACTs in long bones, complications are detected on follow-up imaging examinations in one third of patients, mainly including fractures, incomplete bone graft integration and cement loosening.