Combined Anterior and Lateral Approaches for Bone Tumors of the Femoral Neck and Head

Chondroblastoma is a rare bone tumor predominantly affecting patients during the first and second decades of life. The purpose of this case series is to assist clinicians in establishing a proper diagnosis and treatment method for patients presenting with chondroblastoma of the femoral head. Symptoms of this tumor in the hip joint can be nonspecific, resulting in the critical delay of a proper diagnosis. Due to the aggressive nature of this tumor, an early diagnosis is vital to prevent significant local bone destruction and the potential loss of a mobile hip. The authors present a series of three adolescent patients treated by the primary investigator between 2014 and 2017 for chondroblastoma of the femoral head to help illustrate several diagnostic and treatment principles and considerations for clinicians. The mean Musculoskeletal Tumor Society score at the latest follow-up was 26 points (range: 25–27). No local recurrence was reported in any patient and all individuals have returned to preoperative function, and are participating in daily activities and sports.

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“…There are several studies which report using internal fixation to add additional support to this precarious region. [43][44][45]…”

Section: Discussionmentioning

confidence: 99%

Chondroblastoma of the Femoral Head: A Case Series and Literature Review

et al. 2019

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“…In our study, the choice of surgical approach depended on the location of the lesion within the proximal femur. If the lesion involved the trochanteric or subtrochanteric region, the operation was performed through a lateral approach that provided direct access to the lesion, but if the lesion involved only the neck or head of the femur, the operation was performed through an anterior approach as this approach allowed direct access to the tumor with adequate exposure of the femoral head and neck without dislocation of the hip and complete curettage of the lesion [ 16 ]. However, this approach should be performed with caution to avoid injury of lateral circumflex femoral artery and tumor implantation around the femoral vessels [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of the benign lytic lesions of the proximal femur with synthetic bone graft

Zekry¹,

Yamamoto²,

Hayashi³

et al. 2018

J Orthop Surg Res

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BackgroundBenign bone tumors and tumor-like conditions are commonly located in the proximal femur. The main indications for surgical treatment are lesions with impending or actual pathological fractures, or with aggressive or recurrent lesions. However, patients complaining of persistent pain, limping, or abnormal gait patterns are also considered for surgical treatment. In this study, we describe the outcomes of the surgical treatment of benign lytic lesions of the proximal femur by curettage followed by implantation of synthetic bone graft.MethodsThis retrospective study included 27 patients (22 females and 5 males) with benign lytic lesions of the proximal femur. The average age was 25.5 years (6–65 years), and the mean follow-up period was 54.5 months (9–145 months). The histopathological diagnoses were fibrous dysplasia (8 patients), simple bone cyst (8 patients), chondroblastoma (7 patients), giant cell tumor (3 patients), and eosinophilic granuloma (1 patient). These lesions were managed with curettage followed by implantation of the bone defects with alpha tricalcium phosphate in 14 patients, beta tricalcium phosphate granules in 11 patients, hydroxyapatite granules in 1 patient, and combined beta tricalcium phosphate and hydroxyapatite granules in 1 patient. Internal fixation was performed in three patients.ResultsThe mean operative time was 143 min (80–245 min). Patients had regained normal unrestricted activity without pain at the operation site. Patients treated with beta tricalcium phosphate achieved radiographic consolidation of the bone defects within 1 year after the surgery, and those treated with alpha tricalcium phosphate or hydroxyapatite experienced no progression nor recurrence of the lesions. Local tumor recurrence was observed in one patient with giant cell tumor 5 years after the surgery. Post-operative pathological fracture was occurred in one patient with a simple bone cyst of the subtrochanteric region 1 month after surgery. No post-operative infection was observed.ConclusionWe concluded that the treatment of benign lytic lesions of the proximal femur, either primary or recurrent, using synthetic bone graft is a safe and satisfactory method and the addition of internal fixation should be carefully planned.

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“…Some authors uses combined anterior and lateral approaches for bone tumors extending into neck and head. They reported that anterior approach allows good exposure of head for curettage than lateral approach, but there are high chances of vascular injury, contamination of femoral vessels if postoperative diagnosis was malignant bone tumor [15] . We conclude that non vascularized autologous fibular strut graft with supplementary fixation using cannulated cancellous screws is a safe and effective method of treatment for benign cystic lesions of proximal femur.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of treatment of benign cystic lesions of proximal femur with non-vascularized autologous fibular strut graft and supplementary fixation with cannulated cancellous screw

Tak¹,

Gupta²,

Goel³

2018

Int. J. Orthop. Sci.

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The aim of the study was to evaluate results of benign cystic lesions of proximal femur treated by non vascularized autologous fibular strut graft and supplementary fixation using cannulated cancellous screw. Non vascularized autologous fibular strut graft which act as mechanical as well as biological graft. The hypothesis behind this study to add fixation to fibular strut graft which helps in immediate structural support, early consolidation of defect and remodeling. Methods and Materials: We prospectively and retrospectively evaluated clinical outcomes of surgically treated 8 patients with benign lytic lesions of proximal femur. Out of these 6 were males and 2 females with mean age of presentation was 17 years. Average follow up time was 36 months. Histological diagnosis included simple bone cyst, aneurysmal bone cyst, fibrous dysplasia. Results: 8 patients with benign cystic lesions of proximal femur were treated with curettage and autologous fibular strut grafting. The average operation time was 148 minutes. All patients were allowed unprotected full weight bearing by a mean of 13.2 weeks after surgery. All patients had regained normal unrestricted activity without pain by 12 months of follow up. None of the patients sustained pathological fracture of femur following the surgery. All patients achieved partial or complete consolidation of the lesion within 8 months. None of the patients had local recurrence of tumor in their long follow up. None of the patients were suffered from postoperative wound infection, deep vein thrombosis, chronic hip pain. Conclusion: We conclude that non vascularized autologous fibular strut graft with internal fixation using cannulated cancellous screws is a safe and effective method of treatment for benign cystic lesions of proximal femur.

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Combined Anterior and Lateral Approaches for Bone Tumors of the Femoral Neck and Head

Cited by 15 publications

References 20 publications

Chondroblastoma of the Femoral Head: A Case Series and Literature Review

Chondroblastoma of the Femoral Head: A Case Series and Literature Review

Treatment of the benign lytic lesions of the proximal femur with synthetic bone graft

Clinical outcomes of treatment of benign cystic lesions of proximal femur with non-vascularized autologous fibular strut graft and supplementary fixation with cannulated cancellous screw

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