Use of Massive Allografts to Manage Hydatid Bone Disease of the Femur

Abstract

Hydatid disease is caused by the parasitic tapeworm Echinococcus granulosus. Osseous involvement accounts for 0.5% to 4% of cases in humans. Patients usually are from endemic zones and are initially asymptomatic, presenting with pain and edema at a later stage of disease. However, large lesions may present initially as pathologic fractures. Standard radiographs usually show expansive osteolytic lesions associated with initial cortical thinning, with compromise of the metaphysis or epiphysis, and may involve the diaphysis. The finding of periosteal reaction, osteocondensation, calcification, and clear delimitation of the lesions excludes the diagnosis of osseous hydatidosis. However, there are no specific radiographic signs in the affected bone. There is no generally accepted treatment algorithm for osseous hydatid disease. The usual treatment is surgical resection of the affected bone, followed by antihelmintic therapy. Some patients can be treated with intralesional procedures, such as curettage and allograft or polymethyl methacrylate cement. However, in some advanced cases, such as those with pathologic fractures or recurrences, wide resection may be needed. Several reconstructive alternatives have been reported, such as megaprosthesis, massive allograft, or alloprosthesis composite. The authors retrospectively reviewed 2 cases of femoral hydatidosis treated with wide resection and reconstruction with massive bone allograft. One patient had 5 years of follow-up, and the other had 9 years. No signs of relapse or complications were recorded, and functional outcomes evaluated with the Musculoskeletal Tumor Society scale showed excellent results. These 2 cases support the use of a massive bone allograft as a valid alternative to reconstruction after extensive bone resection for hydatidic disease.

An Uncommon Cause of Soft Tissue Mass of the Extremities, Report of 2 Cases and Review of Literature of Cystic Echinococcosis

“…In general symptoms arise from the expansive effect of the lesion: number, size and developmental status of the cyst (active or inactive) and anatomical site being the critical factors [1]. Musculoskeletal affection usually comes along with a sometimes painful mass, osseous involvement can result in a pathological fracture or -in the case of a spinal lesion -paraplegia and scoliosis [6,14]. The clinical presentation of our 2 cases was quite unspecific.…”

“…The two cases are special because of the isolated musculoskeletal affection. In literature a solitary occurrence in bone is reported in 0,5-4% and in soft tissue only in 0,2-2,2% of cases [1,[12][13][14].Osseous hydatid disease mostly occurs in the spine (35%-60%) and the pelvis (14%-21%) followed by the femur (16%-19%). Tibia, humerus and ribs are rarely affected [5,7,15].…”

“…Therefore -although a variety of diagnostic procedures are available -such cases of cystic echinococcosis most frequently are diagnosed in the wake of surgery [13]. Plain radiographs usually show no pathognomonic calcifications as in cysticercosis [7,14]. Ultrasound and MRI allow visualizing the cystic nature of the disease and are valuable tools for planning surgical resection [15].…”

“…Meticulous surgery in accordance to the principles of musculoskeletal tumor surgery is mandatory to avoid residual infectious tissue and spreading of the parasite [4]. Surgery should be accompanied with the oral administration of an anthelmintic drug aiming at the reduction of the recurrence rate [6,11,14]. Chemotherapy with benzimidazoles (albendazole, mebendazole) is recommended.…”

Periprosthetic pathologic fracture following tibial Echinoccocosis: A case report

“…The bone defect was primarily treated with autologous grafting complemented with polymethyl methacrylate cement on the tibial plateau site placement. The exothermic reaction of cementing can also contribute in preventing recurrence, as referred in some published literature [ 13 , 14 ].…”