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The Journal of Bone and Joint Surgery (American) 83:1674-1681 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Treatment of Aneurysmal Bone Cysts of the Pelvis and Sacrum

Panayiotis J. Papagelopoulos, MD, Sambhu N. Choudhury, MD, Frank J. Frassica, MD, Jeffrey R. Bond, MD, K. Krishnan Unni, MB, BS and Franklin H. Sim, MD

Investigation performed at the Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Panayiotis J. Papagelopoulos, MD
Sambhu N. Choudhury, MD
Frank J. Frassica, MD
Jeffrey R. Bond, MD
K. Krishnan Unni, MB, BS
Franklin H. Sim, MD
Departments of Orthopedic Surgery (P.J.P., S.N.C., F.J.F., and F.H.S.) and Diagnostic Radiology (J.R.B.) and Division of Anatomic Pathology (K.K.U.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. Please address requests for reprints to F.H. Sim.

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Background: Aneurysmal bone cysts are benign, non-neoplastic, highly vascular bone lesions. The purpose of this study was to describe the prevalence, the clinical presentation, and the recurrence rate of aneurysmal bone cysts of the pelvis and sacrum and to examine the diagnostic and therapeutic options and prognosis for patients with this condition.

Methods: Forty consecutive patients with an aneurysmal bone cyst of the pelvis and/or sacrum were treated from 1921 to 1996. Their medical records and radiographic and imaging studies were reviewed, and histological sections from the cysts were examined. Seventeen lesions were iliosacral, sixteen were acetabular, and seven were ischiopubic. Seven involved the hip joint, and two involved the sacroiliac joint. All twelve sacral lesions extended to more than one sacral segment and were associated with neurological signs and symptoms. Destructive acetabular lesions were associated with pathological fracture in five patients and with medial migration of the femoral head, hip subluxation, and hip dislocation in one patient each. The mean duration of follow-up was thirteen years (range, three to fifty-three years).

Results: Thirty-five patients who were initially treated for a primary lesion had surgical treatment (twenty-one had excision-curettage and fourteen had intralesional excision); two patients also had adjuvant radiation therapy. Of the thirty-five patients, five (14%) had a local recurrence noted less than eighteen months after the operation. Of five patients initially treated for a recurrent lesion, one had a local recurrence. At the latest follow-up examination, all forty patients were disease-free and twenty-eight (70%) were asymptomatic. There were two deep infections.

Conclusion: Aneurysmal bone cysts of the pelvis and sacrum are usually aggressive lesions associated with substantial bone destruction, pathological fractures, and local recurrence. Current management recommendations include preoperative selective arterial embolization, excision-curettage, and bone-grafting.


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