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Computer Navigation-Aided Excision of Proximal Femoral Osteochondroma: Surgical Technique. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7635945. [PMID: 35685895 PMCID: PMC9173964 DOI: 10.1155/2022/7635945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/24/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
Purpose Symptomatic osteochondroma of the proximal femur necessitates a surgical excision. The purpose of this study was to describe a novel technique of computer navigation-aided excision for osteochondromata of the proximal femur. Outcomes of this technique are also presented. Methods A total of 13 patients underwent computer navigation-aided excision of osteochondromata of the proximal femur from February 2012 to August 2016 in our institution. They were enrolled in this study. OrthoMap 3D (Stryker Orthopaedics, Mahwah, NJ, USA), a commercially available navigation software system, was used to merge computed tomography images of the proximal femur with an osteochondromata with the image of a normal proximal femur. Using the normal proximal femur as a template, intended resection margins for the proximal femur with osteochondromata were planned and then executed using intraoperative navigation guidance. Patients were followed up clinically and radiographically. The physical and mental health of patients was assessed with the Musculoskeletal Tumor Society (MSTS) score. Results Eight patients had isolated exostoses. Five patients had tumors associated with multiple hereditary exostoses. For tumors projecting posteriorly or posteromedially, a posterolateral approach was used. For tumors projecting anteriorly or medially, an anterior approach was used. Prophylactic fixation was performed in four patients who required an anterior approach. The mean duration of the surgery was 189 minutes. There were no intraoperative fractures or postoperative complications. A secondary procedure was not needed for any case. The mean MSTS score at a mean follow-up of 17 months was 28.6 (maximum MSTS score: 30). Conclusions This is the first study to report a novel application of computer navigation for aiding the excision of osteochondromata of the proximal femur. It demonstrated favorable postoperative functional scores with a low rate of complications. The applicability, safety, and efficacy of this technique were demonstrated. It is particularly useful for resections involving large tumors that can obscure anatomical landmarks and for patients with associated proximal femoral deformity.
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Hammad Y, Saleh (HAA, Aburumman IF, Balasim M, Al-Hyari MI, Al-Ajlouni J. A Rare Case of Intra-articular Osteochondroma of the Femoral Neck: A Case Report. J Orthop Case Rep 2021; 11:91-96. [PMID: 34141651 PMCID: PMC8046481 DOI: 10.13107/jocr.2021.v11.i01.1978] [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] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The osteochondroma (OC) is considered a benign tumor with long bone preference. It presents usually at the metaphyseal part of the bone, with rare cases of intra-articular origins especially in the hip joint. The presentation of such rare cases varies according to its site and mass effect, which may compress the adjacent nerves, tendon, or vascular structures.The femoral neck OC carries a higher risk of femoral head vascular injury and necrosis, as well as sciatic nerve injury, which requires careful preoperative planning and intraoperative cautions. We report a rare case of intra-articular OC in the hip. CASE REPORT A 28-year-old male, presented to our hospital, with complaints of right-side gluteal pain, decrease hip joint extension, and feeling of a hard mass for 2 years. The radiographic evaluation showed an osseous mass related posterior and inferior to the right femur neck, with cortical and medullary continuation, and cartilaginous cap on the magnetic resonance image. The suspicious was OC, and planned for excision and histopathological evaluation. The excision was done through lateral hip approach, and it was intra-articular with marked stretching of the joint capsule. Complete excision was done, as close as possible to the femoral neck cortex using saw and osteotomes, followed by prophylactic fixation using two cannulated screws. The histopathology reports confirm the diagnoses, and the patient started on hip range of motion and abductor strengthening exercises. Over a 4-month follow-up period the patient showed significant improvement in his hip range of motion. CONCLUSION The intra articular OC of the hip is as rare presentation of the OC, which carries the risks of avascular necrosis as well as nerve compression. Clinical suspicion, proper planning, and histopathological evaluation are needed for better results.
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Affiliation(s)
- Yazan Hammad
- Department of Orthopedic Surgery, University of Jordan and Jordan University Hospital, Amman-Jordan, 11942 Aljubeiha, Amman
| | | | - Ibrahim F Aburumman
- School of Medicine, The University of Jordan, Amman, Jordan, 11942 Aljubeiha, Amman
| | - Marwan Balasim
- School of Medicine, The University of Jordan, Amman, Jordan, 11942 Aljubeiha, Amman
| | | | - Jihad Al-Ajlouni
- Department of Orthopedic Surgery, University of Jordan and Jordan University Hospital, Amman-Jordan, 11942 Aljubeiha, Amman
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Sakamoto A, Okamoto T, Matsuda S. Insufficiency fracture at an osteochondroma bridging the proximal fibula and the tibia: Case report. J Orthop 2018; 15:384-387. [PMID: 29881159 DOI: 10.1016/j.jor.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
Osteochondromas are benign bone tumors that protrude from underlying bone. A fracture of an osteochondroma is rare, and no insufficiency fractures of an osteochondroma have been reported. A 57-year-old female complained of pain in her proximal leg that increased during walking. A computed tomographic image depicted bridging that had extended to the tibia. An incomplete fracture line was observed at the osteochondroma. The osteochondroma was resected to remove the bridge. The preoperative symptoms disappeared after surgery. It was challenging to diagnose an osteochondroma with an insufficiency fracture because the symptoms varied in accordance with daily activity.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
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Wang SI, Park EH, Yoon SJ, Kim JR. Intra-articular osteochondroma of the posteroinferior femoral neck associated with hip joint osteochondromatosis: A case report. Mol Clin Oncol 2017; 7:915-918. [PMID: 29181188 DOI: 10.3892/mco.2017.1411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/04/2017] [Indexed: 11/06/2022] Open
Abstract
Osteochondromas are usually extra-articular lesions originating from the metaphysis of long bones. Intra-articular osteochondromas may also occur, causing pain and discomfort and restricting the range of motion. Osteochondromas of the femoral neck are intra-articular lesions that are difficult to access for surgical resection, particularly when located posteriorly. We herein present a rare case of an intra-articular osteochondroma involving the posteroinferior aspect of the femoral neck associated with secondary synovial osteochondromatosis (SOC) of the hip joint in a 25-year-old woman. Determining the optimal treatment was difficult due to the high risk of avascular necrosis (AVN) following surgical excision. The patient was successfully treated with arthroscopic surgery and she remained in good condition at 2 years postoperatively, with a full range of motion of the hip joint, and without signs of limping, recurrence of the SOC, or AVN of the femoral head.
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Affiliation(s)
- Sung Il Wang
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk 561-756, Republic of Korea
| | - Eun Hae Park
- Department of Radiology, Chonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk 561-756, Republic of Korea
| | - Sun Jung Yoon
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk 561-756, Republic of Korea
| | - Jung Ryul Kim
- Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeollabuk 561-756, Republic of Korea
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Sorel JC, Façee Schaeffer M, Homan AS, Scholtes VAB, Kempen DHR, Ham SJ. Surgical hip dislocation according to Ganz for excision of osteochondromas in patients with multiple hereditary exostoses. Bone Joint J 2016; 98-B:260-5. [PMID: 26850433 DOI: 10.1302/0301-620x.98b2.36521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We report a prospective cohort study of the midterm results of surgical dislocation of the hip (according to Ganz) to perform resection of osteochondromas involving the femoral neck in patients with multiple hereditary exostoses (MHE). METHODS Hip range of movement (ROM) was assessed pre- and post-operatively. Patients' judgment of post-operative reduction of pain, symptoms, the Rand 36-item Health Survey (RAND-36) and complications were analysed. RESULTS Symptomatic osteochondromas of the femoral neck were removed in 20 hips (17 patients) between 2007 and 2012. There were nine men and eight women with a mean age at the time of surgery of 29 years (11 to 47). Mean follow-up was 46 months (26 to 73). At latest follow-up, mean ROM was significantly increased in all directions. Post-operatively the pain associated with the lesion was either significantly decreased or non-existent. There was a significant improvement in seven RAND-36 sub-domains. Encountered complications in four patients were pseudoarthrosis of the trochanteric osteotomy, traumatic separation of the trochanteric osteotomy, a pertrochanteric femoral fracture and avasvular necrosis. Histological analysis revealed osteochondromas in all hips. DISCUSSION This study confirms the Ganz trochanteric flip osteotomy provided a reliable approach to osteochondromas of the femoral neck that are otherwise difficult to access for surgical resection. The procedure offered significant improvement in the quality of life, although one should be aware of the serious complications can arise despite the relatively safe procedure. TAKE HOME MESSAGE When daily function and activities are affected, resection of osteochondromas of the proximal femur according to Ganz is indicated to significantly improve quality of life.
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Affiliation(s)
- J C Sorel
- Department of Orthopaedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Oosterpark 9, 1090 HM Amsterdam, The Netherlands
| | | | - A S Homan
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - D H R Kempen
- Onze Lieve Vrouwe Gasthuis , Amsterdam, The Netherlands
| | - S J Ham
- Onze Lieve Vrouwe Gasthuis , Amsterdam, The Netherlands
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A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis. Case Rep Orthop 2015; 2015:709608. [PMID: 26504606 PMCID: PMC4609413 DOI: 10.1155/2015/709608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/20/2015] [Indexed: 11/17/2022] Open
Abstract
A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA), secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient's hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients.
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Jung HT, Hwang DS, Jeon YS, Kim PS. Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report. Hip Pelvis 2015; 27:43-8. [PMID: 27536601 PMCID: PMC4972619 DOI: 10.5371/hp.2015.27.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/17/2015] [Accepted: 02/23/2015] [Indexed: 11/24/2022] Open
Abstract
A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.
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Affiliation(s)
- Heung-Tae Jung
- Department of Orthopedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Deuk-Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yoo-Sun Jeon
- Department of Orthopedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Pil-Sung Kim
- Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, Korea
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