Solitary proximal end of femur osteochondroma. An indication and result of the en bloc resection without hip luxation

Ramos-Pascua, L.R.; Sánchez-Herraéz, S.; Alonso-Barrio, J.A.; Alonso-León, A.

doi:10.1016/j.recote.2011.08.001

Cited by 6 publications

(11 citation statements)

References 16 publications

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“…It is of paramount importance to obtain adequate exposure. To provide surgical access to this location, a variety of approaches have been reported, including the posterolateral approach [ 8 , 10 , 11 ], the Smith-Petersen approach (also known as the anterior approach) [ 16 ], the medial Ludloff approach [ 17 ], and the digastric approach [ 18 ] with accompanying hip dislocation. To facilitate tumor removal, it is obviously necessary to permit tumor visualization.…”

Section: Discussionmentioning

confidence: 99%

“…The medial proximal femur is a biomechanically important structure [ 19 ]. Femoral neck fractures as complications after resecting osteochondroma at this location have been reported [ 16 , 20 ]. In the present study, patients underwent resection with either a posterolateral approach or an anterior approach aided by computer navigation for confirmation of appropriate axes.…”

Section: Discussionmentioning

confidence: 99%

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Computer Navigation-Aided Excision of Proximal Femoral Osteochondroma: Surgical Technique

Sun

Chan

Yang

et al. 2022

Computational and Mathematical Methods in Medicine

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Purpose. Symptomatic osteochondroma of the proximal femur necessitates a surgical excision. The purpose of this study was to describe a novel technique of computer navigation-aided excision for osteochondromata of the proximal femur. Outcomes of this technique are also presented. Methods. A total of 13 patients underwent computer navigation-aided excision of osteochondromata of the proximal femur from February 2012 to August 2016 in our institution. They were enrolled in this study. OrthoMap 3D (Stryker Orthopaedics, Mahwah, NJ, USA), a commercially available navigation software system, was used to merge computed tomography images of the proximal femur with an osteochondromata with the image of a normal proximal femur. Using the normal proximal femur as a template, intended resection margins for the proximal femur with osteochondromata were planned and then executed using intraoperative navigation guidance. Patients were followed up clinically and radiographically. The physical and mental health of patients was assessed with the Musculoskeletal Tumor Society (MSTS) score. Results. Eight patients had isolated exostoses. Five patients had tumors associated with multiple hereditary exostoses. For tumors projecting posteriorly or posteromedially, a posterolateral approach was used. For tumors projecting anteriorly or medially, an anterior approach was used. Prophylactic fixation was performed in four patients who required an anterior approach. The mean duration of the surgery was 189 minutes. There were no intraoperative fractures or postoperative complications. A secondary procedure was not needed for any case. The mean MSTS score at a mean follow-up of 17 months was 28.6 (maximum MSTS score: 30). Conclusions. This is the first study to report a novel application of computer navigation for aiding the excision of osteochondromata of the proximal femur. It demonstrated favorable postoperative functional scores with a low rate of complications. The applicability, safety, and efficacy of this technique were demonstrated. It is particularly useful for resections involving large tumors that can obscure anatomical landmarks and for patients with associated proximal femoral deformity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computer Navigation-Aided Excision of Proximal Femoral Osteochondroma: Surgical Technique

Sun

Chan

Yang

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Tschokanow reported two cases of lesser trochanter osteochondroma: the first case operated by anterior approach which got complicated by femoral vein laceration and sciatic nerve palsy, the second case operated in two-staged procedure (anterior and lateral) with a two month interval without any complication. With the use of anterior (3 patients) and posterolateral (3 patients) approaches 15 , Ramos-Pascua performed surgical excision in six patients without hip dislocation 16 . Feeley and Kelly have reported the use of hip arthroscopy as a treatment modality for femur neck exostosis without any known complications 17 .…”

Section: Discussionmentioning

confidence: 99%

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

et al. 2020

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<p>The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes.</p>

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“…Obtaining adequate exposure is of paramount importance, and different authors have described the use of a variety of approaches to provide surgical access to this area. These include the anterior (Smith-Petersen) approach [12], the posterolateral approach [4,6,7] the digastric approach [13] with accompanying hip dislocation, and the medial Ludloff approach [14]. Apart from permitting tumor visualization to facilitate removal, adequate exposure is essential to allow the surgeon to minimize unnecessary surgical trauma to this structurally important location.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from permitting tumor visualization to facilitate removal, adequate exposure is essential to allow the surgeon to minimize unnecessary surgical trauma to this structurally important location. The biomechanical importance of the medial proximal femur [15] cannot be overstated, and femoral neck fractures [12,16] are a well described complication of resection of osteochondromata at this location. In our study, the patients underwent either an anterior or posterolateral surgical approach to expose the tumors depending on the location of the base of the tumor and the direction to which it projected.…”

Section: Discussionmentioning

confidence: 99%

Proximal femoral osteochondroma excision aided by computer navigation: surgical technique and case series

Sun¹,

Chan²,

Niu³

EPiC Series in Health Sciences

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Purpose:Surgical excision is frequently indicated for symptomatic osteochondroma of the proximal femur. The purpose of this study was to describe our experience with computer-navigation aided excision of osteochondromata in the proximal femur and the outcomes of this technique.Methods:Seven patients who underwent computer-navigation aided excision of proximal femoral osteochondromata were studied. Computed tomography images of each patient's proximal femur and a size-matched normal proximal femur were fused on a commercially available navigation planning software. The intended resection margins were then plotted using the normal proximal femur as a template, and the plan executed using intra-operative navigation guidance. Patients were followed clinically, radiographically and with functional scoring using the Musculoskeletal Tumor Society (MSTS) score.Results:Five patients had isolated exostoses, while two had tumors associated with multiple hereditary exostoses. A posterolateral approach was used for tumors projecting posteriorly or posteromedially, while an anterior approach was used for anteriorly and medially based tumors. Prophylactic fixation was performed in the four patients that required anterior approaches. Mean duration of surgery was 196 minutes. No intraoperative fractures or post-operative complications occurred, and no secondary procedures were necessary. The mean MSTS score at a mean follow up of 13.1 months was 28.8 (out of a maximum of 30).Conclusions:This series is the first report of this novel application of computer-navigation, and demonstrates favorable post-operative functional scores and a low complication rate. It demonstrates the applicability, safety and efficacy of this technique, and is particularly applicable in resections involving particularly large tumors that obscure anatomical landmarks and in patients with associated proximal femoral deformity.

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Solitary proximal end of femur osteochondroma. An indication and result of the en bloc resection without hip luxation

Cited by 6 publications

References 16 publications

Computer Navigation-Aided Excision of Proximal Femoral Osteochondroma: Surgical Technique

Computer Navigation-Aided Excision of Proximal Femoral Osteochondroma: Surgical Technique

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

Proximal femoral osteochondroma excision aided by computer navigation: surgical technique and case series

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