Chronology of the radiographic appearances of the calcium sulphate–calcium phosphate synthetic bone graft composite following resection of bone tumours—a preliminary study of the normal post-operative appearances

To describe the normal chronological radiographic appearances of the calcium sulphate–calcium phosphate (CaSO₄/CaPO₄) synthetic graft material following bone tumour resection during the processes of graft resorption and new bone incorporation into the post-resection defect.

Retrospective review of our oncology database identified patients who had undergone serial radiographic assessment after treatment with the CaSO₄/CaPO₄ synthetic graft following bone tumour resection. Post-operative radiographs were assessed for (1) partial resorption of graft material with partial ingrowth of new bone at the graft site and (2) complete resorption of graft material with complete incorporation of new bone into the graft site. The pattern of resorption of graft material was also documented. Any radiographic evidence of complication was recorded. Radiographs were also divided into groups according to their interval from surgery to establish a pattern of time-related changes.

A total of 11 patients were identified from our database. Partial resorption of graft material/partial ingrowth of new bone was seen in nine patients, initially observed at a mean of 1.4 months from surgery. Resorption commenced peripherally with gradual inward progression in 100% (9 of 9) of cases. Complete resorption of graft/complete new bone incorporation at the graft site was seen in 89% (8 of 9) of cases followed up for more than 5 months after surgery. The other patient developed recurrence of tumour at 14 months, before complete incorporation was demonstrated. The mean time to complete incorporation of new bone was 5 months. Two patients have, to date, been followed up at 2 and 3 months respectively with a pattern of peripheral graft resorption observed so far in both cases. Ten of 13 (77%) radiographs performed 1–3 months after surgery demonstrated peripheral resorption of graft material with partial osseous ingrowth into the defect. Seven of eight (88%) radiographs performed 6–12 months after surgery demonstrated complete new bone incorporation at the graft site with graft material completely resorbed. Ten of 11 (91%) radiographs performed 1 year after surgery demonstrated complete new bone incorporation, the other examination demonstrating recurrence.

Our preliminary observations suggest a characteristic, time-related radiographic pattern during the processes of CaSO₄/CaPO₄ bone graft resorption and complete new bone incorporation. This pattern can be directly related to processes that occur at the molecular level. Radiographic findings that are not in keeping with this may merit closer follow-up.