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Proximal Femur Radical Resection and Reconstruction with Proximal Femur Tumor Prosthesis

February 01, 2014

Contributors: James C Wittig, MD, FAAOS; Camilo E Villalobos, MD; Adem Abrham, ; Rodolfo A. Zamora, SR; Peter Gold, BA; Peter Gold, BA

A 47-year-old woman presented with activity-related right hip pain for 2 months, which occasionally woke her at night. She uses crutches to maintain nonweight-bearing status, and does not have numbness or tingling in her lower extremity. Radiology studies revealed a lytic lesion of the right proximal femur and displayed the lesion as involving the subtrochanteric area through the femoral neck with a ring-arc-like calcification on its distal portion. MRI of the thigh demonstrated a poorly defined zone of transition with an 8-mm satellite nodule on its distal margin. CT of the pelvis revealed a pathologic fracture of the right femoral neck most likely reflective of primary chondrosarcoma. A chest-abdomen-pelvis CT suggested no metastatic disease. The preoperative diagnosis was for a primary chondrosarcoma of the right proximal femur. Previous series of treatment of nondisplaced pathologic fractures attributable to a primary chondrosarcoma were indicated by an immediate open biopsy and stabilization to confirm diagnosis and prevent further displacement. Open biopsy was performed followed by prophylactic stabilization surgery with the dynamic hip screw technique. Final pathology revealed the mass to be a low-grade chondrosarcoma of the right proximal femur. A proximal femur prosthesis was the best option because this large lesion was protruding out of the bone. In this case, treatment was indicated for radical resection and prosthetic reconstruction. A right proximal femur bipolar tumor prosthesis was used for reconstruction. Multiple muscle rotation flaps were used, and neuroplasty of the sciatic nerve was performed. Lastly, we reconstructed the hip abductor musculature and hip joint capsule. The surgery was completed without complications. Radical resection and prosthetic reconstruction is a safe and reliable method for the treatment of nondisplaced pathological fracture attributable to low-grade primary chondrosarcoma.

Results for "Hip and Pelvis"