Fatigue Testing of Different Treatment Options for a Bone Cavity: A Randomized, In Vitro, Biomechanical Cadaver Study in the Proximal Tibia of Goats.

Background Giant cell tumor of the bone is mostly managed with extended intralesional curettage. A bone cavity after curettage is mostly managed with bone cement or bone cement supplemented with nail or plate. This study aimed to determine the treatment option for a bone cavity with maximum time to fatigue failure under sinusoidal reverse bending stress. The results of this study will help determine the standard treatment for a bone cavity. Methodology In this study, bone cavities managed with different treatment options in the proximal tibia of goat cadavers were subjected to sinusoidal reverse bending stress until fatigue failure. The time taken to fatigue failure was used to plot the SN curves for the different treatment options, and the SN curves were analyzed for significance. Results Of the 317 goat specimens, 60 satisfied the inclusion criteria. The mean time to fatigue failure was maximum for the bone cavity treated with bone cement supplemented with a plate. The mean time to fatigue failure (seconds) for bone cement supplemented with a plate was 924 ± 74.4, 606.5 ± 102.8, and 271.2 ± 32.7 for cyclical bending loads of 1, 3, and 5 kg, respectively. The Mann-Whitney U test was used to detect a significant difference between the two independent treatment groups using bone cement supplemented with nail and bone cement supplemented with a plate. The test statistic Z was -1.99, and the p-value for a two-tailed hypothesis was 0.04. Conclusions Based on this in vitro biomechanical study on goat cadavers, we recommend treatment of the bone cavity after intralesional curettage with bone cement supplemented with a plate for maximum resistance to mechanical stress and early rehabilitation.