scholarly journals Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jingtian Shi ◽  
Zhiqing Zhao ◽  
Taiqiang Yan ◽  
Wei Guo ◽  
Rongli Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Local Recurrence ◽  
Head And Neck ◽  
Pathological Fracture ◽  
Intralesional Curettage ◽  
Osteolytic Lesions ◽  
Open Physis ◽  
Surgical Methods ◽  
Common Diagnosis

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.

scholarly journals Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck

2021 ◽  
Vol 51 (7) ◽  
Author(s):  
Tryssia Scalon Magalhães Moi ◽  
Marco Aurélio Molina Pires ◽  
Kelly Cristiane Ito Yamauchi ◽  
Luís Gustavo Gosuen Gonçalves Dias ◽  
Bruno Watanabe Minto
Keyword(s):  
Femoral Head ◽  
Connective Tissue ◽  
Femoral Neck ◽  
Head And Neck ◽  
Pathological Fracture ◽  
Good Alternative ◽  
Fibrous Connective Tissue ◽  
Limb Function ◽  
Mixed Breed

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.

scholarly journals Limb-Sparing Using Total Hip Arthroplasty in a Dog with Femoral Head Osteosarcoma

2017 ◽  
Vol 45 ◽  
pp. 6
Author(s):  
Fernando Yoiti Kitamura Kawamoto ◽  
Aflailton Zeponi ◽  
Wanderley Severo Dos Santos Júnior ◽  
Luís Guilherme De Faria ◽  
Guilherme Galhardo Franco ◽  
...  
Keyword(s):  
Femoral Head ◽  
Local Recurrence ◽  
Total Hip Arthroplasty ◽  
Head And Neck ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Hip Replacement ◽  
Appendicular Skeleton ◽  
Total Hip

Background: Osteosarcoma (OSA) is the most common primary bone tumor of the appendicular skeleton of dogs. It mainly affects the metaphyseal region of long bones in large and giant breed dogs.The markedly aggressive and metastatic character of the disease leads to an invariably poor to unfavorable prognosis.Although amputation is commonly performed, different surgical techniques may be used to preserve the limb. The most common methods of limb preserving surgeries involve the use of endoprosthesis and allogeneic or autologous grafts. This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck.Case: This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck. The OSA stage IA located in the femoral head and neck was resected and treated through the limb-sparing. The bone defect and joint function was reconstructed with total hip arthroplasty technique using a cementless hip prosthesis. The result of the histopathological analysis of the excised bone tissue showed a minimally productive osteoblastic osteosarcoma. To date, the patient shows satisfactory movement rate and motion range, with no pain to palpation and without lameness in that limb. The radiographic follow-up after 24 months showed no local recurrence, metastasis pulmonary or complications related to the implant. Total hip arthroplasty resulted in safe recovery of orthopedic signs associated with osteosarcoma of the femoral head and neck, effectively acting as a limb preserving surgery after 32 months.Discussion: The limb-sparing procedure is an option to control local tumors that has become more popular among owners that do not accept the amputation of the limb. Similarly, it is a good alternative when another condition may interfere with the other limbs or may require amputation of another limb. The size and the potential for weight gain of the dog in this study could compromise its ambulation later, and it was a factor in the decision for the limb-sparing surgery. The allografts can be used to reconstruct the proximal femur, but they were not considered a viable option for this patient because of the reported complications, including graft fracture, non-union with the host bone and collapse of subchondral bone. The hip region does not allow the realization of arthrodesis because this joint is highly mobile, so the use of prosthetics as described is ideal for the preservation of joint biomechanics. Furthermore, the implant provides rapid postoperative recovery and immediate stability. Mean survival times were not significantly different between the limb-sparing and amputation techniques without adequate chemotherapy. In this case, despite the recommendation, the patient was monitored continuously without the association of adjuvant treatments according to the owner’s choice. The complications related with the use of cortical allograft, endoprosthesis, and pasteurized autograft include infection (31-60%), local recurrence (15-28%) or implant failure (11-40%). The implant luxation is the most common non-traumatic acute complication in the short term after limb-sparing surgery of proximal femur in humans and total hip replacement in dogs. To date, no complications have been observed after the procedure was performed. In conclusion, preservation of limbs in cases of osteosarcoma is favorable depending on the degree of involvement, but it requires specific techniques according to the location, to improve the quality of life and animal survival. In this case, the total hip arthroplasty for initial osteosarcoma in the femoral head and neck got an unexpected result, especially given the nature of osteosarcoma, limitations of wide excision with this approach and lack of adjuvant therapy.

scholarly journals What are the outcomes of core decompression in patients with avascular necrosis? Protocol for a systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 71 ◽  
Author(s):  
Octavian Andronic ◽  
Haitham Shoman ◽  
Ori Weiss ◽  
Vikas Khanduja
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Cochrane Library ◽  
Decompression Surgery ◽  
Surgical Methods ◽  
Staging Systems ◽  
Augmentation Techniques

Background: Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The eventual clinical and radiological outcome following this procedure is varied in literature. Also, the time to a total hip replacement (THR) from the index procedure and the percentage of patients subsequently undergoing a THR is controversial. Furthermore, there are multiple surgical methods along with multiple augmentation techniques and various classification and staging systems described. The purpose of this systematic review, therefore, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. Methods: This protocol is being developed in line with the PRISMA-P guidelines. The search strategy includes articles from Medline, Embase, Google Scholar, CINHAL and Cochrane library. The review and screening will be done by two independent reviewers. Review articles, editorials and correspondences will be excluded. Articles including patients with sickle cell disease and with core decompression where augmentation is used will be excluded. The risk of bias and quality of articles will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for the different study designs included. Discussion: This study will be a comprehensive review on all published articles having patients with AVN of the femoral head and undergoing core decompression surgery only. The systematic review will then define the outcomes of the core decompression surgery based on clinical and radiological outcomes. Each outcome will include the different stages within it and finally, the total mean time to THR will be calculated. This will then be followed by assessing the cumulative confidence in evidence from all the data collected using the GRADE tool.   Registration: This systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42018100596

Giant cell tumor of the femoral head and neck: result of intralesional curettage

2009 ◽  
Vol 130 (11) ◽  
pp. 1329-1333 ◽  
Author(s):  
Hwan Seong Cho ◽  
Il-Hyung Park ◽  
Ilkyu Han ◽  
Seung Chul Kang ◽  
Han-Soo Kim
Keyword(s):  
Femoral Head ◽  
Head And Neck ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Cell Tumor ◽  
Intralesional Curettage

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

2017 ◽  
Vol 33 (03) ◽  
pp. 163-172 ◽  
Author(s):  
Cassandra Ligh ◽  
Jonas Nelson ◽  
John Fischer ◽  
Stephen Kovach ◽  
L. Levin
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Head And Neck

Does Delay in Starting Treatment Affect the Outcomes of Radiotherapy? A Systematic Review

2003 ◽  
Vol 21 (3) ◽  
pp. 555-563 ◽  
Author(s):  
Jenny Huang ◽  
Lisa Barbera ◽  
Melissa Brouwers ◽  
George Browman ◽  
William J. Mackillop
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Head And Neck Cancer ◽  
Local Recurrence ◽  
Head And Neck ◽  
Neck Cancer ◽  
Term Survival ◽  
Combined Analysis ◽  
The Impact ◽  
The Relationship

Purpose: The objective of this study was to synthesize what is known about the relationship between delay in radiotherapy (RT) and the outcomes of RT. Methods: A systematic review of the world literature was conducted to identify studies that described the association between delay in RT and the probability of local control, metastasis, and/or survival. Studies were classified by clinical and methodologic criteria and their results were combined using a random-effects model. Results: A total of 46 relevant studies involving 15,782 patients met our minimum methodologic criteria of validity; most (42) were retrospective observational studies. Thirty-nine studies described rates of local recurrence, 21 studies described rates of distant metastasis, and 19 studies described survival. The relationship between delay and the outcomes of RT had been studied in diverse situations, but most frequently in breast cancer (21 studies) and head and neck cancer (12 studies). Combined analysis showed that the 5-year local recurrence rate (LRR) was significantly higher in patients treated with adjuvant RT for breast cancer more than 8 weeks after surgery than in those treated within 8 weeks of surgery (odds ratio [OR] = 1.62, 95% confidence interval [CI], 1.21 to 2.16). Combined analysis also showed that the LRR was significantly higher among patients who received postoperative RT for head and neck cancer more than 6 weeks after surgery than among those treated within 6 weeks of surgery (OR = 2.89; 95% CI, 1.60 to 5.21). There was little evidence about the impact of delay in RT on the risk of metastases or the probability of long-term survival in any situation. Conclusion: Delay in the initiation of RT is associated with a decrease in LRR in breast cancer and head and neck cancer. Delays in starting RT should be as short as reasonably achievable.

Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture

2018 ◽  
Vol 100-B (12) ◽  
pp. 1626-1632 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. M. Tillman ◽  
L. M. Jeys ◽  
J. Gregory ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Local Recurrence ◽  
Giant Cell ◽  
Pathological Fracture ◽  
Univariate Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Giant Cell Tumours

Aims The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). Patients and Methods A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. Results The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. Conclusion In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.

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