Background: Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for\nmechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl\nmethacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of\nthe study is to show that good functional result can be achieved with curettage and bone filler, regardless of type.\nMethods: A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment\nand placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and\nparesthesia. Complication rates at our single institution were compared against literature values for three\nstudy cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Zscore\nfor two populations were used to compare our subset against literature values and between different\nbone filling types.\nResults: Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which\nthe bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate\nof 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any\ncomplications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had\nsample sizes too small for statistical comparison. Statistical comparison yielded no significant difference\nbetween complications in any of the filling groups (P = 0.411).\nConclusions: Some has even argued that bone defects following curettage do not require bone filling for\ngood outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be\nconferred by filling large bone defects. There was no significant difference in postoperative complication rates\nbetween allograft, bone graft substitute, and PMMA when compared at our institution and with literature\nvalues. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent\nreconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as\na suitable alternative to other bone filling modalities.
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