Hereditary Multiple Exostoses of the Hip

El-Fiky, Tarek; Chow, Wang; Li, Yun Hoi; To, Michael

doi:10.1177/230949900901700207

Cited by 26 publications

(20 citation statements)

References 21 publications

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“…The presence and severity of symptoms in the hip are related to the location of osteochondromas 8. Lesions in the medial femur and periacetabular region cause more pain as they alter the hip parameters and its development resulting in acetabular dysplasia and coxa valga.…”

Section: Discussionmentioning

confidence: 99%

Bilateral total hip arthroplasty in a young man with hereditary multiple exostoses

et al. 2015

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We report a rare case of a young man with hereditary multiple exostoses (HME) who presented with severe pain in the hips, requiring bilateral total hip arthroplasty (THA), along with excision of the exostoses. The reported incidence of exostoses around the hip has been reported from 30% in some series to 90% in other studies of HME. These patients may remain asymptomatic, but if not, their symptoms are usually related to the presence of the exostoses itself and the possibility of hip osteoarthrosis is frequently overlooked. This may account for a low incidence of THA for this condition. Surgical management often remains challenging as such lesions are not commonly encountered in the clinical practice and are often very difficult to treat.

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Section: Discussionmentioning

confidence: 99%

Bilateral total hip arthroplasty in a young man with hereditary multiple exostoses

et al. 2015

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“…The osteochondromas can result in abnormal mechanical forces that may drive the dysplasia. It has also been hypothesized that coxa valga may contribute to the dysplasia [5, 26, 30]. There is no consensus in the current literature with respect to surgical treatment for hip osteochondromas when associated with acetabular dysplasia (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Hip Joint Osteochondroma: Systematic Review of the Literature and Report of Three Further Cases

Makhdom

Jiang

Hamdy

et al. 2014

Advances in Orthopedics

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The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our surgical management of three paediatric patients who had femoral neck or acetabular osteochondromas in association with acetabular dysplasia. We performed a systematic review using PubMed and Embase databases for all studies that reported surgical treatments for patients with peritrochanteric or acetabular osteochondroma with or without acetabular dysplasia. We also retrospectively reviewed three patients who were diagnosed with a hip osteochondroma in association with actetabular dysplasia. These patients were known to have hereditary multiple exostoses (HME). The systematic review revealed 21 studies that met our inclusion criteria. All studies were case reports and retrospective in nature and failed to conclude a uniform treatment plan. The three reported cases illustrate successful excision of hip osteochondromas and treatment of acetabular dysplasia. Early excision of hip osteochondromas might prevent acetabular dysplasia in HME patients. Routine radiographic pelvic survey at the time of diagnosis of HME is recommended for early detection of hip osteochondromas and acetabular dysplasia in these children.

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“…Patients with an HEA <25° were included in group 1 (horizontal physis group) and the remaining patients were included in group 2 (non-horizontal physis group) (Table 1 ). The following parameters were also measured (Figure 1 ): (1) The femoral neck-shaft angle (NSA) was the angle between a line passing through the midway of the femoral shaft and another line joining the femoral head center and midpoint of the femoral neck (normal, 120–135° for individuals aged ≥12 years) [ 5 ]. (2) The acetabular index (AI) was formed by a horizontal line connecting both triradiate cartilages (Hilgenreiner's line) and a second line that extended along the acetabular roof [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…Proximal femur lesions have been reported in 30%–90% of patients with HME [ 1 , 2 ] and its symptoms are coxa valga, hip dysplasia, and hip joint subluxation [ 4 - 7 ]. Previously, the incidence of coxa valga was reported as 25%–88.9% [ 1 , 4 , 5 , 8 ]. However, we noticed that the majority of patients with HME showed a more horizontal proximal femoral physis (low Hilgenreiner epiphyseal angle [HEA]) even though they had no lesions around the proximal femur at the time of the initial presentation.…”

Section: Introductionmentioning

confidence: 99%

Developmental pattern of the hip in patients with hereditary multiple exostoses

Wang

Park

et al. 2015

BMC Musculoskelet Disord

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BackgroundCoxa valga is a common clinical feature of hereditary multiple exostoses (HME). The current study aimed to determine the unique developmental pattern of the hip in patients with HME and evaluate the factors that influence its progression.MethodsThirty patients (57 hips) with HME were divided into two groups according to the Hilgenreiner epiphyseal angle (HEA). Twenty-two patients (44 hips) including 13 men and 9 women were assigned to group 1 (HEA <25°), and 8 patients (13 hips) including 3 men and 5 women were assigned to group 2 (HEA ≥25°). The mean age at the initial presentation was 6.0 (4–12) years with 6.8 (4–11) years of follow-up in group 1, and 10.4 (8–13) years with 5.4 (2–9) years of follow-up in group 2. We measured the HEA, neck-shaft angle (NSA), acetabular index (AI), center-edge angle (CEA), and migration percentage (MP) for radiographic evaluation.ResultsAmong the hips, 50 (87.7%) hips had coxa valga and 27 (47.4%) hips had abnormal MP (42.1% were borderline and 5.3% were subluxated). There was a significant difference in the HEA and NSA between the groups (p < 0.001 and p < 0.05, respectively). The HEA significantly correlated with the development of the NSA and no correlation was found between the HEA and AI, CEA, and MP.ConclusionsThere was a significant relationship between the HEA at the initial presentation and the NSA at skeletal maturity. We should consider guided growth for patients with lower HEA to prevent significant coxa valga deformity with close follow-up.

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Hereditary Multiple Exostoses of the Hip

Abstract: Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.

Cited by 26 publications

References 21 publications

Bilateral total hip arthroplasty in a young man with hereditary multiple exostoses

Bilateral total hip arthroplasty in a young man with hereditary multiple exostoses

Hip Joint Osteochondroma: Systematic Review of the Literature and Report of Three Further Cases

Developmental pattern of the hip in patients with hereditary multiple exostoses

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