Percutaneous injection of bone cement (Cementoplasty) for the treatment of symptomatic subchondral cysts

Abstract

Objective: To evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for the treatment of symptomatic subchondral cysts of the appendicular skeleton. Methods: A single-center prospective study involving 13 consecutive patients with symptomatic subchondral cysts was done (8 women, 5 men). The average age was 67 years. Patients were treated by percutaneous CTguided injection of bone cement into the subchondral cysts. Surgical treatment was not indicated or not wished by the patients who underwent cementoplasty. The lesions were all located in weight-bearing bones, involving the femoral head, femoral condyle, tibial plateau, talus and calcaneus respectively and consisting of subchondral cysts resulting from degenerative lesions or aseptic osteonecrosis. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at one month and three months after treatment, with long-term follow-up from 2 months to 43 months (average follow-up: 22 months). Results: Patient follow-ups in our series show supportive results within 13 patients, 12 patients were satisfied with a long-lasting result after the procedure had been performed, and would recommend the intervention to relatives. The average evaluation of pain was 8/10 (SD: 0.49) before treatment, 3/10 (SD: 0.66) one month after treatment and 1/10 (SD: 0,60) three months after treatment. Our results show a significant decrease of the pain felt by patients between before procedure and one month after the procedure (p=0,002), before procedure and three months after the procedure (p=0,002), one month after the procedure and three months after the procedure (p=0.011). There were no immediate or delayed complications. We observed one asymptomatic para-articular cement leakage at the knee. One patient was not relieved after the procedure and underwent hip surgery. Conclusions: Percutaneous injection of bone cement under CT and fluoroscopy guidance seems to be an effective and safe procedure in the treatment of symptomatic subchondral cysts with a significant decrease of patient’s pain and a mini-invasive approach compared to classical surgical treatment. Thus we recommend that it should be considered as a first choice of treatment for symptomatic subchondral cysts.