Title : Injectable synthetic bone graft substitute (GeneX) in the surgical management of benign bone tumours: Further experiences from a tertiary musculoskeletal oncology centre
Abstract:
Background: Intralesional curettage is a common treatment for benign bone tumours, often leaving contained bone voids that require filling. There is no national or international consensus regarding the best method or material for filling these defects. GeneX, a synthetic composite of β-tricalcium phosphate and calcium sulfate, offers osteoconductive properties with complete resorption and radiolucency, beneficial for post-operative imaging surveillance with plain radiographs. There is little data published regarding the use of GeneX in this setting, and this case series is intended to add to the evidence bank for surgeons considering its use.
Methods: We conducted a retrospective case series at a tertiary musculoskeletal oncology centre including 22 patients treated between April 2019 and May 2025. All patients underwent curettage of benign lesions with subsequent GeneX implantation. Data on demographics, lesion characteristics, radiographic incorporation, complications, and functional recovery were analysed.
Results: The cohort included 22 patients (13 males, 9 females; mean age 38 years). Most common diagnoses were enchondroma and aneurysmal bone cyst. Radiographic evidence of graft incorporation into bone was observed in 86% of cases within 3–12 months. Of the three without radiographic confirmation, two lacked adequate follow-up imaging—one had no postoperative radiographs, and the other had imaging only at 8 weeks, likely before resorption onset. The final patient experienced wound breakdown and infection necessitating graft removal and revision to PMMA. One non-GeneX-related fracture was managed conservatively. All patients returned to full weight-bearing, with the majority doing so by 6 weeks postoperatively. No tumour recurrences were noted during follow-up (mean: 33.9 months).
Conclusion: GeneX appears to be a safe and effective bone graft substitute for filling contained defects following curettage of benign bone tumours. Its complete resorption and radiolucent final state support its use in oncologic settings where follow-up imaging clarity is essential. Further studies with control groups are warranted to validate long-term comparative outcomes.
