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Pan C, Lian L, Chen J, Huang R. FemurTumorNet: Bone tumor classification in the proximal femur using DenseNet model based on radiographs. J Bone Oncol 2023; 42:100504. [PMID: 37766930 PMCID: PMC10520341 DOI: 10.1016/j.jbo.2023.100504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Background & purpose For the best possible outcomes from therapy, proximal femur bone cancers must be accurately classified. This work creates an artificial intelligence (AI) model based on plain radiographs to categorize bone tumor in the proximal femur. Materials and methods A tertiary referral center's standard anteroposterior hip radiographs were employed. A dataset 538 images of the femur, including malignant, benign, and tumor-free cases, was employed for training the AI model. There is a total of 214 images showing bone tumor. Pre-processing techniques were applied, and DenseNet model utilized for classification. The performance of the DenseNet model was compared to that of human doctors using cross-validation, further enhanced by incorporating Grad-CAM to visually indicate tumor locations. Results For the three-label classification job, the suggested method boasts an excellent area under the receiver operating characteristic (AUROC) of 0.953. It scored much higher (0.853) than the diagnosis accuracy of the human experts in manual classification (0.794). The AI model outperformed the mean values of the clinicians in terms of sensitivity, specificity, accuracy, and F1 scores. Conclusion The developed DenseNet model demonstrated remarkable accuracy in classifying bone tumors in the proximal femur using plain radiographs. This technology has the potential to reduce misdiagnosis, particularly among non-specialists in musculoskeletal oncology. The utilization of advanced deep learning models provides a promising approach for improved classification and enhanced clinical decision-making in bone tumor detection.
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Affiliation(s)
- Canyu Pan
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Luoyu Lian
- Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical, University, Quanzhou 362000, Fujian Province, China
| | - Jieyun Chen
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Risheng Huang
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Rajasekaran RB, Jayaramaraju D, Palanisami DR, Agraharam D, Thippeswamy PB, Rajasekaran S. Role of impaction bone grafting of allografts in the management of benign lesions of the proximal femur. J Orthop 2022; 34:189-195. [PMID: 36104992 PMCID: PMC9465316 DOI: 10.1016/j.jor.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose of study The use of allografts to reconstruct benign lesions of the proximal femur after curettage has seldom been reported. We report our experience of impaction bone grafting of only allografts combined with osteosynthesis to manage benign lesions involving the proximal femur. Materials and methods Between 2013 and 2019, 35 patients of a mean age of 23.8 years (14-41) who had a biopsy proven benign pathology and a median pre-operative Mirels' score of 9 (8-11) were managed using extended curettage, impaction bone grafting of allografts combined with osteosynthesis through a lateral approach. Radiographs were assessed to see for any recurrence at follow-ups, and functional outcomes were assessed using Musculoskeletal Tumour Society (MSTS) score and Harris hip score (HHS). Results At a mean follow-up was 41.5 months (23-80), patients demonstrated favorable functional outcomes with a mean MSTS of 28.3 (18-30) and a mean HHS of 94.3 (66-100) at the last follow-up. Two cases (GCT = 1; fibrous dysplasia = 1) had a recurrence of disease. Allografts demonstrated a particular integration pattern on radiographs that involved an intermediate period of lucency followed by consolidation and integration with the parent bone. Conclusion Impaction grafting of allografts in benign lesions of the proximal femur allows adequate bony consolidation of the cavity after extended curettage and can be effectively used as a permanent solution to manage such lesions in most cases. The intermediate period of lucency seen on radiographs must not be confused for recurrence, and patients must be followed up continuously. Study design Retrospective Case Series. Level of evidence Level IV.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Dheenadhayalan Jayaramaraju
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Dhanasekara Raja Palanisami
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Devendra Agraharam
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Zhou L, Lin S, Zhu H, Dong Y, Yang Q, Yuan T. The blood pressure and use of tourniquet are related to local recurrence after intralesional curettage of primary benign bone tumors: a retrospective and hypothesis-generating study. BMC Musculoskelet Disord 2022; 23:201. [PMID: 35241034 PMCID: PMC8892695 DOI: 10.1186/s12891-022-05157-4] [Citation(s) in RCA: 2] [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: 09/12/2021] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Aims Intralesional curettage is a commonly used treatment for primary bone tumors. However, local recurrence of tumors after curettage remains a major challenge. Questions (1) Is blood pressure related to local recurrence after intralesional curettage for benign or intermediate bone tumors? (2) What’s the impact of tourniquet usage on the risk of recurrence from high blood pressure? Methods This retrospective study evaluated patients receiving intralesional curettage for primary bone tumors from January 2011 to January 2015. A total of 411 patients with a minimum five-year follow-up were included for analysis. Demographic and disease-related variables were first assessed in univariable analyses for local recurrence risk. When a yielded p-value was < 0.2, variables were included in multivariable analyses to identify independent risk factors for local recurrence. Patients were then stratified by tourniquet usage (use/non-use), and risk from high blood pressure was evaluated in both subgroups. Results At an average follow-up of 6.8 ± 1.0 years, 63 of 411 patients (15.3%) experienced local recurrence. In multivariable analyses, local recurrence was associated with age (OR, 0.96; 95% CI, 0.94–0.99; p = 0.005); tumor type; lesion size (> 5 cm: OR, 3.58; 95% CI, 1.38–9.33; p = 0.009); anatomical site (proximal femur: OR, 2.49; 95% CI, 1.21–5.15; p = 0.014; proximal humerus: OR, 3.34; 95% CI, 1.61–6.92; p = 0.001); and preoperative mean arterial pressure (> 110 mmHg: OR, 2.61; 95% CI, 1.20–5.67; P = 0.015). In subgroup analyses, after adjusting for age, tumor type, lesion size, and anatomical site, tourniquet use modified the preoperative mean arterial pressure - recurrence relationship: when tourniquet was not used, preoperative mean arterial pressure predicted local recurrence (95–110 mmHg, 4.13, 1.42–12.03, p = 0.009; > 110 mmHg, 28.06, 5.27–149.30, p < 0.001); when tourniquet was used, preoperative mean arterial pressure was not related to local recurrence (all p values > 0.05). Conclusions A high preoperative blood pressure was related to local recurrence after intralesional curettage for primary bone tumors in our study. Tourniquet usage and controlling blood pressure might be beneficial for reducing local recurrence in patients scheduled to receive intralesional curettage for primary bone tumor treatment. Level of evidence Level IV, hypothesis-generating study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05157-4.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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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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Maes DJA, Kaneuchi Y, Abudu A, Stevenson JD. Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:559-566. [PMID: 34047855 DOI: 10.1007/s00590-021-03015-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). METHODS Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. RESULTS The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. CONCLUSION The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.
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Affiliation(s)
- Danielle J A Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Yoichi Kaneuchi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Department of Orthopaedic Surgery, Fukushima Medical, University School of Medicine, Fukushima, 960-1295, Japan
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Aston University Medical School, Aston University, Birmingham, UK
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Li J, Ze R, Rai S, Tang X, Liu R, Hong P. Is elastic stable intramedullary nail a good choice for pathological fractures of the proximal femur due to simple bone cyst in pediatric population? Medicine (Baltimore) 2020; 99:e22364. [PMID: 32991454 PMCID: PMC7523860 DOI: 10.1097/md.0000000000022364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pathological fracture of the proximal femur represents a challenging situation for orthopedic surgeons because of the high risk of non-union, varus union, and avascular necrosis (AVN) of the femoral head. This study aims to investigate the efficacy of ESINs for the treatment of proximal femoral fractures caused by simple bone cysts (SBCs).All the patients with a diagnosis of proximal femoral fracture secondary to SBC treated with ESINs combined with bone grafting between January 2008 and January 2018, were analyzed retrospectively.In all, 11 patients were included in the Double ESINs group (5.1 ± 0.8 years, 5 male, 6 female) and 27 patients were included in the Triple ESINs group (9.1 ± 2.1 years, 11 male, 16 female). There was no significant difference between the 2 groups concerning the patients demographic parameters, including sex and affected side. However, the age in the Double group was significantly younger than those in the Triple group (P < .001). All patients in both groups displayed excellent outcomes according to the Musculoskeletal Tumor Society Score (MSTS), and there was no significant difference between the 2 groups at a 12-month follow-up evaluation (P = .10). As for the Capanna classification (1 + 2), there was no significant difference between these 2 groups (P = .24). In the Triple ESINs group, 24 (88.9%) patients were categorized in Capanna 1 and 2, whereas all patients in Double ESINs were Capanna 1 and 2. Overall, the success rate was 92%.ESINs combined with bone grafting is a successful strategy for proximal femoral fractures caused by SBCs in the pediatric population.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renhao Ze
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Mahankal, Kathmandu, Nepal
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dheenadhayalan J, Avinash M, Lakhani A, Rajasekaran S. Shepherd's crook deformity: How to set it straight. A five-step surgical guide. J Orthop Surg (Hong Kong) 2020; 27:2309499019834362. [PMID: 30852946 DOI: 10.1177/2309499019834362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Fibrous dysplasia (FD) of the proximal femur can result in severe deformity and disability. The results of surgical management in such situations have been reported to be poor. We present a novel, five-step surgical treatment to correct proximal femoral deformity in FD. MATERIAL AND METHODS This study is a review of prospectively collected data of cases of proximal femur polyostotic FD managed at our institute from 2012 onward. We managed three patients with FD involving four femora (one patient had bilateral disease). Mean age at presentation was 16 years with an average follow-up of 46 months. All underwent five steps, that is, (1) curettage/excision of the lesion, (2) allograft in intramedullary region, (3) lateral closing wedge valgus osteotomy, (4) fixation with extramedullary implant, and (5) augmentation of osteotomy site with autograft. Functional outcome was assessed using Harris Hip Score preoperatively and at the final follow-up. RESULTS The neck shaft angle was corrected from an average of 91.7° to 152.1°, while the Harris Hip Score improved from an average of 59 to 95. There was no clinical or radiological evidence of recurrence of disease or deformity in any patient till the last follow-up. CONCLUSION This five-step technique ensures good functional and radiological outcomes in the management of proximal femur FD.
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Affiliation(s)
| | - M Avinash
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Azhar Lakhani
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Rahman MA, El Masry AM, Azmy SI. Review of 16 cases of aneurysmal bone cyst in the proximal femur treated by extended curettage and cryosurgery with reconstruction using autogenous nonvascularized fibula graft. J Orthop Surg (Hong Kong) 2019; 26:2309499018783905. [PMID: 29954245 DOI: 10.1177/2309499018783905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity. METHODS We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures. RESULTS The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection. CONCLUSIONS Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.
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Affiliation(s)
- Mohamed Abdel Rahman
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Sherif Ishak Azmy
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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A Novel Technique for Single-stage Correction of Severe Shepherd Crook Deformity of a Femur With the Large Cystic Lesion and Pathologic Fracture. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Liu H, Xiong Y, Fang X, Duan H. [Treatment of proximal femoral benign lesions by proximal femoral nail anti-rotation combined with curettage and bone graft through the Watson-Jones approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:893-898. [PMID: 30129314 DOI: 10.7507/1002-1892.201801128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions. Methods The clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function. Results The operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones ( P<0.05). Conclusion The treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
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Affiliation(s)
- Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Liu H, Fang X, Yu Z, Lang Y, Xiong Y, Duan H. Surgical strategy for benign lesions in proximal femur: internal fixation or endoprosthetic replacement. INTERNATIONAL ORTHOPAEDICS 2018; 42:2691-2698. [PMID: 29666889 DOI: 10.1007/s00264-018-3922-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/26/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to explore the indications for the two most frequently applied surgical procedures for benign lesions in the proximal femur. METHODS We retrospectively reviewed 142 patients with benign lesions in the proximal femur from January 2010 to January 2015. Internal fixation (IF) was adopted in 110 patients, while endoprosthetic replacement (EPR) was applied in 32 patients. Clinical data, including operation time, blood loss, hospitalization time, and hospitalization expenses, were compared between the groups. Limb mobilization was evaluated by the Musculoskeletal Tumor Society Score-93 (MSTS-93) and Harris Hip Score (HHS). Local recurrences and complications were statistically compared. RESULTS The average follow-up was 66 months (range 32-84 months). In the EPR group, operation time and hospitalization time were significantly shorter (p < 0.05 and p < 0.05, respectively), while blood loss and hospitalization expenses were significantly higher (p < 0.05 and p < 0.05, respectively). Functional outcomes of the MSTS-93 and HHS were higher at the three week follow-up in the EPR group (p < 0.001 and p < 0.001, respectively) but lower at 6 months (p = 0.031 and p = 0.042, respectively). No differences were observed in the two scores at three months (p = 0.261 and p = 0.134, respectively). Local recurrence and complication rates were similar in the two groups (p = 0.895 and p = 0.942, respectively). CONCLUSION The strategy for benign proximal femur lesions should depend on the site, size, initial diagnosis, and thinning degree of cortical bone. IF and EPR both result in satisfactory local control and functional and radiological results, while EPR is more suitable for aggressive and recurrent lesions and serves as an effective measure after IF failure.
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Affiliation(s)
- Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yun Lang
- Department of Orthopedics, People's Hospital of Deyang City, Deyang, 618000, Sichuan, People's Republic of China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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12
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Abstract
BACKGROUND Benign aggressive bone lesions of the femoral head and neck are mostly seen in young adults and warrant treatment for pain, impending fracture or established fracture, and disease clearance. It becomes challenging to treat them effectively while attempting salvage of the femoral head and yet achieving long term disease control with minimum complications. We describe our technique and experience in dealing with these lesions which can achieve the above-mentioned goals and can be easily replicated. MATERIALS AND METHODS We analyzed 15 cases of surgically treated, biopsy-proven benign, locally aggressive lesions affecting the femoral head and neck in skeletally mature individuals. All cases were treated with extended curettage through anterolateral modified Smith-Petersen approach along with tricortical iliac crest bone graft (combined with fibular graft in some cases) reconstruction with or without suitable internal fixation. RESULTS All, except one, patients were available for follow up. The age ranged from 18 to 43 years and the follow up ranged between 24 and 124 months (average 78 months). These included aneurysmal bone cysts (9), giant cell tumors (4), and fibrous dysplasia (2). The indication was pain (8), with impending (2) or established pathological neck femur fracture (5). In all cases, there was satisfactory healing of lesion and timely rehabilitation. Nonunion, avascular necrosis or local recurrences were not seen. The MSTS functional score was good or excellent in all (range 26-29, average 28). CONCLUSION Benign aggressive lesions affecting femoral head and neck in young and middle-aged adults pose a treatment challenge. A sturdy, lasting reconstruct with acceptable functional outcome and minimal recurrence rate can be achieved by salvaging the femoral head and neck using curettage and reconstruction, obviating the need for replacement at such an early age.
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Affiliation(s)
- Yogesh Panchwagh
- Department of Orthopaedic Oncology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India,Department of Orthopaedic Oncology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India,Address for correspondence: Dr. Yogesh Panchwagh, 101, Vasant, Plot 29, Bharat Kunj Soc. No. 2, Erandwana, Pune - 411 038, Maharashtra, India. E-mail:
| | - Sujit K Joshi
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Centre, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag K Sancheti
- Department of Orthopaedic Oncology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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13
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Errani C, Tsukamoto S, Leone G, Akahane M, Cevolani L, Tanzi P, Kido A, Honoki K, Tanaka Y, Donati DM. Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:813-819. [PMID: 28589498 DOI: 10.1007/s00590-017-1983-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The treatment of giant cell tumor (GCT) of bone remains controversial. Intralesional surgery (curettage) results in a higher rate of local recurrence, but better functional results compared to resection. The aim of this study was to assess whether the use of curettage was successful in the treatment of GCT of long bones. We evaluated the influence of adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence. METHODS We retrospectively reviewed the records of patients treated for GCT of long bones between 1990 and 2013, using curettage. No patient had any treatment other than surgery. After detailed curettage, the bone cavity was filled with bone allografts and/or cement. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum follow-up was 24 months. RESULTS We enrolled 210 patients with GCT of long bones treated by curettage. The rate of local recurrence was 16.2% (34/210 patients). The median follow-up was 89.2 months. In the multivariate analysis, no significant statistical effect on the local recurrence rate could be identified for gender, patient's age, Campanacci's grading, or cement versus bone allografts. The only independent risk factor related to the local recurrence was the site, with a statistically significant higher risk for patients with GCT of the proximal femur. CONCLUSIONS Our observation on the correlation of tumor location and risk of local recurrence is new. We suggest that patients with GCT of bone in the proximal femur should be followed closely soon after surgery to identify any possible recurrence.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy. .,Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli n1, 40136, Bologna, Italy.
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Giulio Leone
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Luca Cevolani
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy
| | | | - Akira Kido
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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14
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Erol B, Topkar MO, Aydemir AN, Okay E, Caliskan E, Sofulu O. A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg 2016; 136:1051-61. [PMID: 27317344 DOI: 10.1007/s00402-016-2486-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE We aimed to develop a surgical treatment strategy for benign bone lesions of the proximal femur based upon retrospective review of our data in 62 children. METHODS Sixty-two children [38 male, 24 female; median age 9 years (range 5-18 years)] with proximal femoral benign bone lesions were surgically treated between 2005 and 2013. Histopathological diagnoses were simple (31) or aneurysmal (27) bone cysts, and nonossifying fibromas (4). The pathological fracture rate was 77.4 %. Surgical treatment was determined due to four criteria, including patient's skeletal maturity, localization and initial diagnosis of lesion, and amount of bone loss in the femoral neck and lateral proximal femur. Surgical procedure consisted of biopsy, curettage, bone grafting, and internal fixation when required. The median follow-up was 45 months (range 25-89 months). RESULTS Complete clinical recovery was achieved in 56 (90.3 %) patients between 4 and 8 months postoperatively; full weight-bearing and mobilization, without pain and limping, was possible. The median preoperative and postoperative last follow-up Musculoskeletal Tumor Society (MSTS) scores were 13.3 % (range 10-23.3 %) and 96.6 % (range 90-100 %), respectively (p < 0.0001). The pathological fractures were healed in 10 weeks on average (range 8-12 weeks). Fifty-seven (92 %) patients demonstrated complete or significant partial radiographic healing between 5 and 7 months that maintained throughout follow-up. Local recurrence was not observed, and only 1 (1.6 %) patient required reoperation for partial cyst healing. There were 5 (8 %) complications, 1 (1.6 %) of which required reoperation. CONCLUSIONS This treatment strategy can provide good local control and excellent functional and radiological results in the management of benign bone lesions of the proximal femur in children.
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Affiliation(s)
- Bulent Erol
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Mert Osman Topkar
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Ahmet Nadir Aydemir
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Erhan Okay
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Emrah Caliskan
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Omer Sofulu
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
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15
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Carvallo PI, Griffin AM, Ferguson PC, Wunder JS. Salvage of the proximal femur following pathological fractures involving benign bone tumors. J Surg Oncol 2015; 112:846-52. [PMID: 26482583 DOI: 10.1002/jso.24072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/08/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To describe the surgical treatment of patients with a pathologic fracture through a benign tumor of the proximal femur to determine if there is a difference in local recurrence, complications or functional outcome compared to patients with tumors in the same location without pathologic fractures. METHODS From 1989-2010, of 97 patients, 29 presented with a pathologic fracture (PF) through a proximal femoral benign bone tumor and 68 presented without a pathologic fracture (NPF). Outcomes of the two groups were compared in terms of surgical management, postoperative complications, local recurrence and functional scores. RESULTS Fibrous dysplasia, giant cell tumor of bone and chondroblastoma were the most common subtypes. Most patients were managed with joint preservation in both PF (86.2%) and NPF (98.5%) groups (P = 0.03). Local recurrence risk was similar for patients in the PF (10.3%) and NPF (8.8%) groups. Mean follow-up was 105.7 months (P = 0.8). Functional outcome scores were high in both groups and not statistically significantly different. CONCLUSIONS The majority of pathologic fractures through a benign bone tumor of the proximal femur can be successfully treated with curettage, burring, bone grafting and internal fixation without increasing the risk of local recurrence or negatively impacting functional outcome.
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Affiliation(s)
- Pedro I Carvallo
- University Post-Graduate Orthopaedic Oncology Program, Universidad Central de Venezuela, Servicios Oncológicos Hospitalarios, Seguro Social, Caracas, Venezuela
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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16
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Abstract
Monostotic fibrous dysplasia of the proximal femur has a variable clinical course, despite its reported limited tendency to progress. We investigated the natural history and predisposing factors for progression of dysplasia in a group of 76 patients with a mean follow-up of 8.5 years (2.0 to 15.2). Of these, 31 (41%) presented with an asymptomatic incidental lesion while 45 (59%) presented with pain or a pathological fracture. A group of 23 patients (30%) underwent early operative treatment for pain (19: 25%) or pathological fracture (4: 5%). Of the 53 patients who were initially treated non-operatively, 45 (85%) remained asymptomatic but eight (15%) needed surgery because of pain or fracture. The progression-free survival of the observation group was 81% (sd 6.4%) at five-years follow-up. An initial presentation of pain (p < 0.001), a limp (p < 0.001), radiological evidence of microfracture (p = 0.001) and younger age (< 17 years) (p = 0.016) were significant predisposing factors for disease progression. The risk of experiencing pain or pathological fracture is considerable in monostotic fibrous dysplasia of the proximal femur. Patients presenting with pain, a limp or radiological evidence of microfracture have a high chance of needing surgical treatment. Cite this article: Bone Joint J 2014;96-B:673–6.
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Affiliation(s)
- I. Han
- Seoul National University Hospital, Department
of Orthopaedic Surgery, 101 Daehak-ro Jongno-gu, Seoul, 110-744, South
Korea
| | - E. S. Choi
- Seoul National University Hospital, Department
of Orthopaedic Surgery, 101 Daehak-ro Jongno-gu, Seoul, 110-744, South
Korea
| | - H-S. Kim
- Seoul National University Hospital, Department
of Orthopaedic Surgery, 101 Daehak-ro Jongno-gu, Seoul, 110-744, South
Korea
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17
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Shin SH, Yeo I, Seo SW. Can certain benign lesions of the proximal femur be treated without surgery? Clin Orthop Relat Res 2013; 471:3319-25. [PMID: 23670674 PMCID: PMC3773140 DOI: 10.1007/s11999-013-3048-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Benign lesions in the proximal femur can cause pathologic fractures. To avoid fracture, benign tumors and tumor-like lesions in this region often are treated surgically, yet there have been few reports regarding the decision-making processes or protocols for nonsurgical treatment of these lesions. QUESTIONS/PURPOSES In this study, we asked (1) whether some benign lesions of the proximal femur can be managed safely using a conservative protocol, and (2) if observed according to such a protocol, what are the outcomes of such lesions at this anatomic site? METHODS Fifty-four consecutive patients who had been followed for at least 12 months were enrolled in this study. The mean age of the patients at first visit was 38 years (range, 13-70 years), and the minimum followup was 12 months (mean, 25 months; range, 12-59 months). After ruling out malignancy, lesions were categorized as aggressive benign tumors or nonaggressive benign lesions using a standardized approach. We used conservative treatment for most patients with nonaggressive, benign lesions. Surgery was performed only for patients with nonaggressive lesions who met our fracture risk criteria: pain on initiating hip movement, progressively worsening pain, cortical thinning, and the absence of a sclerotic margin. RESULTS Of the 47 patients with a nonaggressive, benign lesion without fracture at presentation, 83% were treated conservatively and only 10% of these patients had progression of the lesion. No new pathologic fractures developed during followup. In 88% of patients who presented with pain that was managed conservatively, pain improved either partially or completely at final followup. CONCLUSIONS Most nonaggressive, benign lesions in the proximal femur can be treated conservatively, and our protocol appears to be a useful outpatient guideline. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seung Han Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
| | - Ingwon Yeo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
| | - Sung Wook Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
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18
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Hu YC, Lun DX, Zhao SK. Combined anterior and lateral approaches for bone tumors of the femoral neck and head. Orthopedics 2012; 35:e628-34. [PMID: 22588402 DOI: 10.3928/01477447-20120426-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few reports in the literature describe the treatment experience of benign lesions of the femoral head and neck. Between July 2005 and August 2009, twenty-four patients with bone tumor of the femoral neck and head were treated at the authors' institution. Fourteen patients had pathological fractures of the femoral neck; in the other 10 patients, the bone cortex was involved. Average tumor size was 78 cc (range, 45-130 cc). The patients were treated by curettage plus bone grafting via an anterior approach (Smith-Petersen incision) and internal fixation via a lateral approach (Hardinge approach). Average follow-up was 34 months (range, 10-68 months).Average blood loss and operative time were 450 mL and 87 minutes, respectively. Six patients experienced complications: 2 superficial wound infections, 2 immunological rejections, and 2 hollow screw loosenings and slight limps at 12 and 16 months postoperatively, respectively. No recurrence or other serious complications, such as pathological fracture, ischemic necrosis of the femoral head, or joint degeneration, occurred. Average Musculoskeletal Tumor Society score for lower extremity function was 29.2 (range, 27-30) at final follow-up, and all patients resumed their normal preoperative work and were pain free postoperatively, although 1 patient had a slight limp at final follow-up.A combination of anterior and lateral approaches may produce good clinical and functional results with minimal complications in bone tumors of the femoral neck.
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Affiliation(s)
- Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China.
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19
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Cho HS, Park IH, Han I, Kang SC, Kim HS. Giant cell tumor of the femoral head and neck: result of intralesional curettage. Arch Orthop Trauma Surg 2010; 130:1329-33. [PMID: 20020148 DOI: 10.1007/s00402-009-1026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND There have been not much reports on the result of intralesional excision for giant cell tumors (GCTs) of the femoral head and neck because of its rarity. The purpose of this study is to review the results of patients managed with intralesional curettage for GCT of the femoral head and neck. METHODS We retrospectively reviewed 12 patients with a GCT of the femoral head and/or neck. All of them were treated with curettage and followed up to monitor local recurrence and pulmonary metastasis. Mean duration of follow-up was 58.3 months. RESULTS Although recurrence rate of the present study was rather high (41.7%, 5 of 12 hips), 9 of 12 hips (75%) were preserved at last follow-up including 2 hips that underwent repeat curettage, and functional outcomes of the preserved hips were satisfactory. CONCLUSION It may be that curettage should be considered as a primary treatment of choice for GCTs of the femoral head and neck.
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Affiliation(s)
- Hwan Seong Cho
- Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, Kyungpook National University Hospital, Daegu, Korea
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20
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Errani C, Ruggieri P, Asenzio MAN, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 2009; 36:1-7. [PMID: 19879054 DOI: 10.1016/j.ctrv.2009.09.002] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
Giant cell tumor is still one of the most controversial and discussed bone tumors. Surgical treatment options include intralesional excision or segmental resection. Curettage has a higher recurrence rate but does preserve adjacent joint function. After curettage, the use of adjuvant therapies is still controversial. Three hundred forty-nine patients with giant cell tumors of the extremity, treated in a single institution, were analyzed in a retrospective study. Two hundred patients underwent curettage of the lesion and in 64 of these cases, three local adjuvants, such as phenol, alcohol and cement, were employed. The hypothesis is that an "aggressive curettage" with phenol, alcohol and cement provides better local control and functional results. The correlation between tumor in the proximal femur and higher recurrence rate has not been recorded before. The results of the present study suggest that an "aggressive curettage" reduces the recurrence rate in a disease whose aggressiveness is not easy to predict. Special attention must be given to giant cell tumors not only in the distal radius, but also in the proximal femur, where the treatment is more difficult and associated with a higher rate of local recurrence.
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Affiliation(s)
- Costantino Errani
- Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
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21
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Xu J, Zhang CQ. Salvage of a hip following pathological fracture through a large aneurysmal bone cyst: a case report. Hip Int 2009; 19:148-50. [PMID: 19462373 DOI: 10.1177/112070000901900212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A young lady aged 20 presented to us in 2004 with a pathological fracture of the left femoral neck through a large aneurysmal bone cyst. Instead of total hip arthroplasty, we performed one-stage reconstruction surgery combining internal fixation and free vascularized fibular grafting. At 4 years the structure and function of the hip had been preserved.
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Affiliation(s)
- Jun Xu
- Department of Orthopaedics, Shanghai 6th People's Hospital, Shanghai, China
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22
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Abstract
Fibrous dysplasia is a developmental anomaly of bone formation that accounts for approximately 7% of benign bone tumors. It exists in a monostotic or polyostotic form, commonly occurs in the proximal femur, and may require total hip arthroplasty (THA) for its management in a select group of patients. The results of THA in patients with this disorder is not known. Of the 27,543 primary THAs performed at our institution between 1969 and 2001, 10 were in patients with fibrous dysplasia (prevalence of 0.04%). Two other patients (2 hips) with the same diagnoses were referred after a failed primary THA. The study group comprised 7 men and 4 women (1 bilateral) with an average age at primary THA of 44 years (range, 23-66 years). Four patients had the monostotic form and 7 patients had the polyostotic form. A cemented stem was used in 7 hips and cementless stem in the rest (N=12). Average follow-up was 15.7 years (range, 2-30 years). Seven hips in 6 patients were revised for loosening of components at an average of 12.5 years, and 2 of these were re-revised for the same reason. Loosening of a cementless femoral component led to early revision in 3 hips. The surgical outcomes for patients with monostotic was better than those with polyostotic disease. Long-term fixation of the femoral component is of concern in patients with fibrous dysplasia. Total hip arthroplasty provided these patients with long-lasting pain relief and function despite the higher rate of complications at the time of surgery.
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Affiliation(s)
- Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA
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23
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Sakayama K, Sugawara Y, Kidani T, Miyawaki J, Fujibuchi T, Kamei S, Aizawa J, Yamamoto H. Diagnostic and therapeutic problems of giant cell tumor in the proximal femur. Arch Orthop Trauma Surg 2007; 127:867-72. [PMID: 17713773 DOI: 10.1007/s00402-007-0419-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Indexed: 02/09/2023]
Abstract
Primaly giant cell tumor of bone (GCT) in the proximal femur is relatively rare, and can prove difficult to diagnose, and can require therapeutic methods. Subjects comprised 10 patients (8 males, 2 females). Mean patient age was 27.5 years, and mean follow-up was 89.9 months. Tumors in the present study were limited to H1 and H2 according to the International Society of Limb Salvage (ISOLS) system. All patients received surgical treatment only. Second surgery after preoperative open biopsy was performed for two patients, while the remaining eight patients received excisional biopsy to determine treatment methods using rapid intraoperative pathological examination of frozen sections. The mean functional score was 28.2 out of 30 (93.9%). Local recurrence was observed in two patients. The long-term follow-up reveals that one of the important problem is pre-operative diagnosis. Excisional biopsy is effective for surgery of GCT in the proximal femur.
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Affiliation(s)
- Kenshi Sakayama
- Department of Orthopaedic Surgery, Ehime University School of Medicine, Shitsukawa, Toon, 791-0295, Ehime, Japan.
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24
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Abstract
UNLABELLED Treatment of pathologic femoral neck fractures secondary to extensive lesions of fibrous dysplasia and simple bone cysts has been controversial. We think that modified Pauwels' intertrochanteric osteotomy and osteosynthesis can result in sound healing of the lesion and of the fracture, with no recurrence, low complication rates, and good functional results. Seven patients were treated with a uniform approach consisting of biopsy (Stage I) and osteotomy with osteosynthesis (Stage II). Curettage of the lesion and bone grafting were not done. The average followup was 79.28 months (range, 32-142 months). All of the fractures and osteotomy sites healed in means of 14 weeks (range, 12-16 weeks) and 9.1 weeks (range, 8-10 weeks), respectively. All fibrous dysplasia lesions healed radiologically. Grade IV radiographic healing was seen in both patients with simple bone cysts after 35 and 92 months. Using the Musculoskeletal Tumor Society functional evaluation and Toronto Extremity Salvage Score, all the patients had good to excellent results. Complications such as infection, local recurrence, refracture, femoral neck deformity, osteonecrosis of the femoral head, and growth arrest of capital femoral physis were not seen. In addition to biomechanical advantages, the procedure seems to have had a biologic role in healing of the fracture and of the lesion by initiating osteogenesis to replace the defect with new bone. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- N K Magu
- Departments of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak (Haryana) India.
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25
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26
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Abstract
Fractures through bone tumors are often difficult to treat. We reviewed our combined experience with this problem in children, as well as the existing literature, to formulate management guidelines. For this study, prospective databases (1987 to 2002) from three referral centers were screened for pathologic fractures occurring under the age of 14 years. One hundred five patients presented with fracture through unicameral bone cyst, nonossifying fibroma, fibrous dysplasia, aneurysmal bone cyst and osteosarcoma. Seventeen patients were excluded. The most common primary locations were the proximal humerus and proximal femur. Pathologic fracture through nonossifying fibroma had the best outcome; union occurred with nonsurgical treatment in all cases. Unicameral bone cyst required surgical treatment to avoid persistence of the cyst and refracture. However fracture healing was predictable without surgical treatment. Proximal femoral lesions tended to heal in malunion if not fixed surgically. Aneurysmal bone cyst required surgical treatment for the lesion to heal and to allow the fracture to heal as well. Percutaneous sclerotherapy may be the treatment of choice for many of these lesions. Fibrous dysplasia allows fracture healing with nonoperative therapy. Progressive deformity requires followup and surgical correction. Malignant lesions presenting a pathologic fracture are best managed by initial nonoperative therapy during investigation and neoadjuvant therapy when possible, followed by definitive treatment.
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Affiliation(s)
- Eduardo J Ortiz
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Unit, Fundación Hospital Alcorcon, Madrid, Spain.
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