Articulated distraction of the hip joint in the treatment of benign aggressive tumors located around the hip joint
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Introduction. The proximal femur and acetabulum are frequent sites for benign active and aggressive lesions. The risk of pathologic fracture is great when a bone-destroying pathology involves an anatomic location such as the hip joint that undergoes profound mechanical loading. If the destruction involves a large area around the joint, secure fixation cannot be achieved with internal fixation implants. The study investigates use of articulated hip distraction to protect reconstructions performed for the treatment of benign active or aggressive tumors presenting with pathologic fracture. Patients and methods. Five patients with a pathologic fracture of the proximal, intracapsular femur or the acetabulum were operated on at the authors' institution between 1997 and 1999. Following histopathologic approval of a benign tumor, all lesions were curetted, chemocauterized, and grafted and osteosynthesis was performed. The reconstruction was protected with an articulated hip distraction external fixator. All patients were mobilized in the immediate postoperative period. Results. The patients were kept in external fixators for an average of 19.8 weeks (range: 16-24). The fixator was removed when bony consolidation was observed in anteroposterior and lateral x-rays of the lesion. The patients were followed for an average of 47 months (range: 38-56) after frame removal. None of the lesions recurred. At the last follow-up examination, all patients displayed an excellent function according to the Musculoskeletal Tumor Society Rating Scale. Conclusion. According to the authors' knowledge, this investigation is the first in the literature describing the use of articulated joint distraction in the treatment of benign active and aggressive lesions around the hip joint. The procedure adopts principles of joint distraction into bone tumor surgery.
- Makale