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Muratori F, Scanferla R, Roselli G, Frenos F, Campanacci DA. Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications. BMC Musculoskelet Disord 2023; 24:139. [PMID: 36814214 PMCID: PMC9945643 DOI: 10.1186/s12891-023-06239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage. METHODS We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur's head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient. RESULTS Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed. CONCLUSION More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy.
| | | | | | - Filippo Frenos
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy
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Katagiri H, Takahashi M, Murata H, Wasa J, Miyagi M, Honda Y. Direct femoral head approach without surgical dislocation for femoral head chondroblastoma: a report of two cases. BMC Surg 2022; 22:327. [PMID: 36038855 PMCID: PMC9422087 DOI: 10.1186/s12893-022-01766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chondroblastomas are rare, benign, locally aggressive lesions that appear in the epiphysis. Surgery for femoral head chondroblastoma (FHCB) is difficult. Conventional treatment with curettage via a drilled tunnel along the femoral neck can damage the growth plate and is associated with high local recurrence rates. The trapdoor procedure, which directly facilitates lesion access from the femoral head articular surface, can reduce local recurrence and avoid growth plate damage, although it requires surgical dislocation. Little is known about the long-term results of this direct articular surface approach, and there are no case reports on trapdoor procedures without dislocation. CASE PRESENTATION We report two cases (patients aged 12 and 15 years) of FHCB presented with coxalgia treated using the trapdoor procedure without surgical dislocation. Both surgeries were performed with patients in the semi-lateral position. The hip joint was exposed via an anterior approach, and a capsulotomy was performed at the superior rim of the acetabulum, followed by the external rotation of the hip joint. With a fine osteotome, a rectangular flap (trapdoor) was opened on the cartilage surface in the lateral non-weight-bearing area, and curettage of the lesion followed by bone and/or bone substitute grafting was performed. Subsequently, the trapdoor was replaced in its original position. There has been no local recurrence or femoral head aseptic necrosis after more than 6 and 12 years for patients 1 and 2, respectively. Both patients had musculoskeletal tumor society scores of 100% at follow-up and are enjoying a normal active life. CONCLUSIONS This direct femoral head approach without dislocation may be a simple treatment alternative for FHCB.
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Affiliation(s)
- Hirohisa Katagiri
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan.
| | - Mitsuru Takahashi
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Hideki Murata
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Junji Wasa
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Michihito Miyagi
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
| | - Yosuke Honda
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan
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Su Q, Zhang Y, Zhang Y, Zhao B, Ge H, Wu P, Li J, Cheng B. Rapid and Severe Idiopathic Aseptic Necrosis of the Contralateral Femoral Head after Unilateral Total Hip Arthroplasty. Orthop Surg 2022; 14:1251-1259. [PMID: 35524630 PMCID: PMC9163970 DOI: 10.1111/os.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, and agnogenic ONFH, otherwise known as idiopathic ONFH, is rare in clinic. Idiopathic ONFH that exhibits severe necrosis and progresses extremely rapidly is called rapidly destructive hip disease (RDHD). RDHD greatly affects patients but is rarely reported in clinical practice and literature. CASE PRESENTATION In this study, a 64-year-old male patient with complete collapse and necrosis of the right femoral head complicated with severe bone destruction at 10 months after left total hip arthroplasty (THA) was reported. The period from the intact structure of the right femoral head to the first discovery of its complete collapse, according to imaging results, was 7 months. The duration from the occurrence of symptoms in the right hip joint to the first discovery of complete collapse and necrosis of the femoral head was only 5 months. At present, the cause has not been determined based on medical history, symptoms, signs, imaging evaluation results, laboratory examination results, and pathological examination results, though it has been identified as severe idiopathic aseptic necrosis of the femoral head with rapid progression, or RDHD. Finally, right THA was performed, and a good outcome was observed in the patient at present. CONCLUSIONS As a rare hip joint disease, RDHD greatly influences the normal life of patients. RDHD of the contralateral side after unilateral THA is even scarcer. Left THA may be one of the important factors accelerating the necrosis of the right femoral head. Hopefully, with this case report, more attention will be paid to the contralateral hip joint in patients undergoing unilateral THA by clinicians and rehabilitation physicians, and a clinical reference will be provided for the research on RDHD.
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Affiliation(s)
- Qihang Su
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yi Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yuanzhen Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Bin'an Zhao
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jun Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of MedicineTongji UniversityShanghaiChina
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Abo-Elsoud M, Sadek W, Salah-Eldeen M, Abosenna W. Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety. INTERNATIONAL ORTHOPAEDICS 2021; 46:653-660. [PMID: 34799777 DOI: 10.1007/s00264-021-05264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. PATIENTS AND METHODS Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14-20) and a mean follow-up of 34 ± 12 months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. RESULTS We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). CONCLUSION This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Wael Sadek
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Salah-Eldeen
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wesam Abosenna
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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Shi J, Zhao Z, Yan T, Guo W, Yang R, Tang X, Qu H, Dong S. Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review. BMC Musculoskelet Disord 2021; 22:549. [PMID: 34134687 PMCID: PMC8210383 DOI: 10.1186/s12891-021-04442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background and objectives Treatment of benign osteolytic lesions in the femoral head and neck can be extremely challenging, particularly in children with open physis or for aggressive tumors with pathological fracture. There remains the difficult management decision as to whether to perform complete excision of the involved area or only curettage. Moreover, there is no agreed consensus on the optimal approach to lesion access when performing curettage, which included the transcervical, open and direct approach. The current systematic review aims to provide guidance for selection of surgical methods in clinical practice by comparing the advantages and drawbacks of different procedures. Methods A comprehensive literature search of PubMed, Embase and Web of Science databases were executed for human studies restricted to the English language. The search was filtered to include studies published from January 1980 to January 2020. Results A total of 33 articles including 274 patients were enrolled in the final analysis. The most common diagnosis was chondroblastoma (CBT) (104, 38.0%), followed by giant cell tumor (GCT) (56, 20.4%). There were 57 (20.8%) patients with pathological fracture. Intralesional curettage was performed in 257 (93.8%) patients with the local recurrence of 12.5% at the mean follow-up of 51.5 months. The patients who were presented with open physis or curetted via transcervical approach developed higher local recurrence in patients with CBT (P < 0.001). The local recurrence rate of GCT is 33.3% after curettage, while 8 of 9 (88.9%) patients with fracture were treated successfully with joint preservation. Two of 45 (4.4%) patients developed avascular necrosis (AVN) of femoral head after surgical hip dislocation. The reported Musculoskeletal Tumor Society (MSTS) Score was comparable among patients with different approaches to curettage. Conclusion The majority of benign osteolytic lesions in the femoral head and neck can be treated with intralesional curettage with acceptable local tumor control and satisfactory function. The incidence of local recurrence might be decreased dramatically for lesion access under direct visualization. The native joint maintenance could be achieved even in patients with aggressive lesions presenting pathological fracture. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04442-y.
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Affiliation(s)
- Jingtian Shi
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Sen Dong
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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