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

Abstract

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.

Surgical hip dislocation according to Ganz for excision of osteochondromas in patients with multiple hereditary exostoses

“…The main surgical objectives are to obtain an adequate exposure of the lesion(s) without damaging the femoral head vascularity while protecting the neurovascular structures around the hip. The surgical approach is usually dictated by the location of the osteochondroma 4,20,27,30,36 each of which has some limitation or disadvantage. Whereas release of the gluteus medius and the tensor fascia lata during the anterior dislocation of the hip with the Smith-Petersen approach is associated with post-operative abductor complaints, 20 posterior approaches require release of the short external rotator muscles which may damage the MFCA and the inferior gluteal artery.…”

“…26 In the currently sparse literature on multiloculated/broad based or circumferential osteochondromas, surgical approaches varied considerably from single anterior or posterior to extensive combined or the Ganz surgical dislocation of the hip. 15,[24][25][26][27] Although there is no uniform strategy for treatment of proximal femoral osteochondromas, dislocation of the femoral head using the Ganz approach provides excellent exposure of the femoral neck and acetabulum in wellselected cases. This exposure facilitates complete en-bloc resection of the osteochondroma while limiting the risk of damaging intra-and peri-articular structures during resection.…”

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

“…This uncommon condition has an incidence of 1 in 50 000 population, with autosomal dominant inheritance of variable penetrance 6 7. The exostoses in HME are usually diagnosed in the first decade of life in affected individuals (80%).…”

Benign Bone Tumors about the Hip

“…Use of intraoperative fluoroscopy can also help guide the surgeon in localizing the lesion and verifying adequate resection. 19…”