A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

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.

Atypical May-Thurner Syndrome Caused by Large Lumbar Osteophyte

“…4 The prevalence of vascular compression due to osteophytic outgrowth is commonly reported in the literature with reports of femoral and abdominal aortic compression and even aortic pseudoaneurysm due to osteophytes. 6 7 8 This presentation is more likely to occur in an older population due to the time it takes for these osteophytes to reach clinically significant size. Patients with DVT and MTS routinely require endovascular stenting as the standard of care due to the high risk of recurrence.…”

Extrinsic venous compression secondary to spine osteophytes

“…The first case was described in 1948 in a patient with large osteophytes compressing the aorta, leading to acute lower extremity ischemia and death. 7 Werner-Gibbings and Dubenec 8 reported a 69-year-old patient with extensive subclavian vein thrombosis secondary to an osteophyte of the sternoclavicular joint, and Takasago et al 9 described a case of a patient with massive unilateral leg edema secondary to femoral vein compression against a big hip osteophyte.…”

Lumbosacral exostosis as a rare cause of iliac vein compression and significant limb swelling

“…Cases of osteophytes causing vascular compression and subsequent vascular compromise are common in the literature. For example, cases of Paget-Schroetter syndrome, thrombosis of the abdominal aorta, and compression of femoral vessels by osteophyte complexes have been reported 8, 9, 10. Surgical treatment typically consists of relieving the symptoms of vessel compression while reducing the chances of recurrent compromise or thrombosis.…”