Hip joint remodeling in an adult following excision of a giant cell tumor involving the acetabulum: a case report and literature review

An acetabular-preserving procedure for pelvic giant cell tumor involving partial acetabulum

Background

The management of pelvic giant cell tumors (GCTs) involving the acetabulum remains a challenge for surgeons on how to balance the relative benefits of minimizing recurrence and maintaining postoperative hip function. The present study was to present and evaluate the clinical indications, operative technique, and outcomes of pelvic GCTs involving partial acetabulum treated with multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless total hip arthroplasty (THA).

Methods

We retrospectively reviewed seven patients with pelvic GCTs involving partial acetabulum who underwent multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA from January 2010 to October 2014. We assess the outcome including the bone graft healing, nonunion, hardware failure, infection, tumor recurrence, and metastasis. And the functional outcome was evaluated by the Musculoskeletal Tumor Society (MSTS)93 score.

Results

All patients were followed up for a mean of 38.1 months (range 26–61 months). All bone grafts are union. No failure of acetabular components, wound healing problem, or deep infection was suspected. No patient experienced metastasis. Recurrence was observed in one out of seven patients, treated by extended resection and implanting iodine ions in the surgical area. The mean MSTS93 score was 29.4 (range 28–30). All patients were disease-free and resumed activities of daily living at the most recent follow-up.

Conclusions

As long as one of the two columns is retained and the resulting defect does not exceed the supra-acetabular line, multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA is a viable strategy for the treatment of pelvic GCTs involving partial acetabulum. However, a large-scale prospective clinical study is still needed to verify these procedures.

Use of extended curettage with osteotomy and fenestration followed by reconstruction with conservation of muscle insertion in the treatment of Enneking stage II locally aggressive bone tumor of the proximal extremities: resection and treatment of bone tumors

Background

The purpose of this study was to investigate the clinical efficacy of extended resection with osteotomy, fenestration and conservation of muscle (tendon) insertion in the treatment of bone tumors.

Methods

A total of 15 patients with locally aggressive bone tumors (Enneking stage II) in the adjacent muscle (tendon) insertion of the proximal extremity were enrolled in the present study (mean age of 29 years). Extended curettage of lesions with osteotomy, fenestration and/or conservation of muscle (tendon) insertion and internal fixation with a bone graft or bone cement was performed at stage I. Postsurgical brace protection was used for 4 to 12 weeks and the patients were periodically followed-up by X-ray and functional assessment. Recurrence, postsurgical Enneking score and outcome rating were assessed.

Results

Treated cases included 15 patients aged 29 ±7.75 years (range, 18 to 42) with a male to female ratio of 8:7. Six had a femoral tumor and nine had a humeral tumor. These tumors comprised three chondroblastomas, five giant-cell tumors and seven aneurysmal bone cysts. Follow-up for 48 ±12.95 months (range, 25 to 72) revealed that 13 of 15 (87%) patients exhibited no recurrence. Local recurrence was observed in a patient with an aneurysmal bone cyst (nine months) and one with a giant-cell tumor (12 months). Mean Enneking scores were 27 ±4.07 (range, 18 to 29). Except for the patient with the recurrent giant-cell tumor, all patients reported good (13%, 2 out of 15) or very good (80%, 12 out of 15) outcomes. Very good outcomes were reported in 92% of patients (12 out of 13) without recurrence.

Conclusions

The procedures used in this study achieved high clinical efficacy, complete lesion removal, reduced recurrence and good restoration of joint function in patients with primary locally aggressive Enneking stage II bone tumors of the proximal extremities.