King Fahd Hospital

Probably GCT so en bloc excision better than attempted curettage and fixation

See this month’s JBJS(US)

A Total Hip Arthroplasty better than a hemi-arthroplasty

Chris Wilson

University Hospital

Cardiff

Biopsy first, en-bloc excision if nasty and Metal on metal THR. Hopefully will give him the longest life of implant. If its just a cyst (unlikely), 3 cannulated screws + fibula graft.

Hello Magdy

I think that this case needs to be investigated in a classic fashion, i.e. MRI, then biopsy. I think it looks more like a bone cyst. At any rate, I think that this head appears to be unsalvageable. Therefore, it should be excised. Then for reconstruction, you have either an arthrodesis (cobra plate), or bipolar hemiarthroplasty depending on the patient's lifestyle and occupation. I do not think that the acetabulum should be resurfaced if its surface has not been affected.

Good luck.

Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com

Dear All

During the discussion of the last case presented by Dr Magdy Anwar about a pathologic fr neck of femur in a young individual, some colleagues proposed THR climing that it was better than a hemiarthroplasty.

Now I have had a similar debate with an eminent hip surgeon from Egypt who spoke about Bipolar hemiarthroplasty disapprovingly. Now I know that Metal on Metal THR is the latest fashion and that the preliminary results are amazing and the life expectancy of the prosthesis is superior and all that. However, I wonder whether it is appropriate to resurface a healthy acetabulum which could give some pain-free years, and then be resurfaced probably using ceramics if you are looking for longevity. What I am asking is: Is it appropriate to destroy / resurface a healthy acetabulum in order to put a MOM prosthesis and (hypothetically) gain a few more years?

Thanks.

Dr Abdelsalam EID M.D., AFSA (Paris V)

Assalam o alaikum my dear Brothers in Madinah Al Munawarh.

I miss you all and hope to see you inshaAllah in the new year.

This patient has most probably Giant Cell tumour. Biopsy is needed to confirm this.

Wide excision and Total hip replacement is the best option in this case.

Masalam

Khurshid Shah

2 weeks back I had a similar case of path #. Age is 31, site neck of femur but is extending down upto subtrochanteric area. Biopsy report is ABC.Shall sent the X ray and CT.

Dr.Dominic Puthoor

Ortho Oncologist &Assi. Professor

Dept of Orthopedics

Amala Institute of Medical Sciences

Trichur, Kerala; India

Simply why implant something that will fail, will cause protrusio, will create HDPE debris and may cause groin pain as opposed to something that may last him the rest of his life ? By putting a bipolar in, you are destroying his acetabulum anyway.

Dr Sanjay Bhattacharyya

Consultant Arthroplasty & Orthopaedic Trauma Surgeon.

I think you take a percutaneous ct guided biopsy, if
it's benign lesion, bone cust, enchondrom..etc, you
proceed to internal fixation and bone graft and
supplement with bone paste, like calcium
phosphate...etc,
if it's malignant, the it should be excised and
reconstructed, most preferably by vascularized double
barrel fibular graft...
Yours,
M M Kotb, MD Ortho.

In my case I tried a CT guided biopsy. Pathologist failed to give a definite opinion. When I opened there was a blood filled cavity. I sent it for imprint cytology. Pathologist though could not give a diagnosis, could say there is no evidence of malignancy. I curetted the cavity, fixed with DHS and filled the cavity with bone cement.

Dr.Dominic Puthoor

Ortho Oncologist &Assi. Professor

It might be aneurysmal bone cyst. I will attache 3
x-ray films of of this diseas in femur and tibia.

Another case of aneurysmal bone cyst in iliac.

Ma Zhen-sheng