Solitary Osteochondroma of the Proximal Femur and Femoral Acetabular Impingement

Abstract

Although osteochondromas can be present within the context of multiple hereditary exostosis, these tumors are overwhelmingly found as isolated lesions. Increased exostotic load associated with multiple hereditary exostosis can lead to limb-length discrepancy, increased femoral anteversion, valgus angulation, and acetabular dysplasia. Despite these observations, the relationship of more common isolated exostoses near the proximal femur and their role in femoral acetabular impingement has never been depicted. Although solitary osteochondromas have been linked with bursal inflammation and pain, compression on neurovascular structures, and malignant degeneration, they have not previously been associated with femoral acetabular impingement. This article presents a novel case of a proximal femoral osteochondroma of the greater trochanter leading to the development and associated symptoms and radiographic findings consistent with hip impingement. A 24-year-old man presented with groin and lower extremity pain thought to be due to an exostosis of the proximal femur. Following surgical excision and persistence of anterior groin pain, the patient was found to display a presentation and radiographic findings consistent with femoral acetabular impingement. He successfully underwent a hip arthroscopy, femoroacetabular osteochondroplasty, and labral repair. Postoperatively, his symptoms improved significantly, and he returned to normal activity. The presence of a proximal femoral exostosis can be associated with the development of femoral acetabular impingement. Awareness of this relationship may lead to a better understanding of patient symptoms and expectations associated with treatment.

A mountain among molehills: removing an impinging large femoral neck osteochondroma in a man with hereditary multiple exostoses

“…Although one previous study has described the treatment of FAI due to solitary osteochondroma,2 this case serves to highlight proximal femoral osteotomy as a viable treatment for FAI in the setting of HME.…”

The arthroscopic management of a cotyloid fossa lesion with concurrent hip dysplasia

“…14 Osteochondroma provoking symptoms around the hip has been reported, although the reports are limited to management of lesions of the acetabulum in children or arthroscopic intervention for femoral neck lesions in adults. Hussain et al 15 reported a case of femoroacetabular impingement secondary to exostoses of the greater trochanter, developing a link between extraarticular osteochondroma and intraarticular labral damage and demonstrating the value of hip arthroscopy in such cases. This concept was developed further by Feeley and Kelly 16 in a report of labral tear secondary to a proximal femoral exostosis, this time of the femoral neck.…”

Coxa saltans caused by extraarticular synovial chondromatosis overlying an isolated osteochondroma of the greater trochanter: A rare aetiology

“…Osteochondroma of the proximal femur as a cause for hip pain is relatively rare and very few cases are reported till now. Hussain et al 4 have reported femoral acetabular impingement secondary to osteochondroma. Schaberg et al 5 have reported two cases of internal snapping hip due to proximal femur exostosis.…”