title: Treatment of juxta-articular intraosseous cystic lesions in rheumatoid arthritis patients with interconnected porous calcium hydroxyapatite ceramic.
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.
authors.affiliation: Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Kuriyama
authors.forename: Jun
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Murase
authors.forename: Masakazu
authors.initials: M
authors.lastname: Fujii
authors.forename: Akihide
authors.initials: A
authors.lastname: Nampei
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirao
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsuboi
authors.forename: Akira
authors.initials: A
authors.lastname: Myoui
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001845:Bone Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D003286:Contracture; D003475:Curettage / Q000379:methods; D017886:Durapatite / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011859:Radiography
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement; D017886:Durapatite