Cystic bone lesion curettage is a fundamental orthopedic oncology procedure used to treat benign intraosseous cystic and tumor-like lesions while preserving bone structure and function. The technique involves creating a cortical window over the lesion (large enough to allow thorough exposure), evacuation of cystic contents (fluid, blood, fibrous tissue), and meticulous mechanical removal of the lesion lining and surrounding pathologic tissue using sharp curettes of various sizes and shapes, ensuring complete debridement of the cavity walls.
Adjuvant therapies are essential to reduce local recurrence rates by addressing microscopic disease that escapes mechanical curettage: high-speed burr (rotary burr that extends curettage 1-2 mm into apparently normal bone), chemical cautery with phenol (5%, applied for 1-3 minutes), thermal ablation with cryosurgery (liquid nitrogen creates -196°C destruction extending 2-3 cm from cavity), argon beam coagulation, and polymethylmethacrylate (PMMA) cement (provides exothermic reaction during polymerization plus cytotoxic effect). Choice of adjuvant depends on lesion type, location, surrounding structures, and surgeon preference.
Common indications include: unicameral bone cyst (UBC) — benign fluid-filled cyst typically in proximal humerus or femur in children, often heals spontaneously but persistent symptomatic cases require curettage; aneurysmal bone cyst (ABC) — locally aggressive blood-filled lesion with septations on imaging, requires aggressive curettage with adjuvants; fibrous dysplasia — focal benign condition with curettage and grafting for symptomatic monostotic disease; giant cell tumor of bone — locally aggressive benign tumor with high recurrence (15-30% even with adjuvants), denosumab now used as neoadjuvant or alternative; chondroblastoma — benign cartilage tumor in epiphyses; non-ossifying fibroma if symptomatic; selected metastatic lesions for palliation. Defect reconstruction options include autologous bone graft (iliac crest, fibula), allograft (cancellous, structural), bone substitute (calcium phosphate, calcium sulfate), or cement (PMMA — provides immediate structural support and oncologic adjuvant effect, can be subsequently revised). Outcomes: 75-95% lesion control depending on type, with recurrence requiring further intervention or sometimes wider resection.