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Hip joint osteochondroma: systematic review of the literature and report of three further cases.

1. Introduction

Osteochondromas are benign osteocartilaginous primary tumours of long bones typically found in the forearm, knees, or ankles [1]. They commonly involve the metaphysis and can cause significant deformities, restriction of range of motion (ROM), persistent pain, and growth disturbance [1-3]. They may occur as a solitary lesion or as multiple lesions in the context of hereditary multiple exostoses (HME), an autosomal dominant disorder with an approximate prevalence of 1 in 50,000 in the general population [4, 5]. Several studies in the literature have reported the occurrences of these lesions in the hip and acetabulum [6-25]. Acetabular dysplasia and coxa valga occur in approximately 25% of HME patients [5]. It has been suggested that acetabular dysplasia and femoral neck osteochondromas may independently or synergistically contribute to the increased risk of lateral subluxation of the hip [26]. Typically, surgical intervention is considered when these features are present. However, the surgical management for such lesions remains challenging for orthopaedic surgeons as they are not commonly encountered in clinical practice. The primary aim of this study is to systematically review the literature with regards to the surgical treatment of patients with hip osteochondromas. The secondary aim is to present our surgical management for three paediatric patients who had hip subluxation secondary to femoral neck/acetabular osteochondromas in association with acetabular dysplasia.

2. Materials and Methods

The systematic review was performed using PubMed and Embase databases. Our search terms included "hip osteochondroma," "proximal femoral osteochondroma" "femoral neck osteochondroma," and "acetabular osteochondroma" as well as "acetabular dysplasia" in combination with the previously mentioned terms and "osteochondroma acetabular dysplasia." The inclusion criteria were all articles that included patients with proximal femur/acetabular osteochondroma with or without acetabular dysplasia and who underwent surgical excision. Exclusion criteria included the following: (1) inadequate description of surgical treatments, (2) articles published in abstract form only, and (3) nonrelevance to the subject of interest. Our goal was to explore the surgical treatments as well as the reported complications in the literature.

In the authors' center, between the year of 2000 and 2011, three patients were diagnosed with hip osteochondromas in association with acetabular dysplasia. After approval from our Institutional Review Board, these three cases were retrospectively reviewed. There were two females and one male and all were known to have HME. The left hip was affected in all patients. Clinical data and basic demographics are summarized in Table 1.

3. Results

3.1. Literature Review. Our initial search revealed 163 articles found in the PubMed and Embase databases. After removing 20 duplicated articles, 143 articles were reviewed and retained for analysis. Of these, 122 articles were excluded leaving 21 articles meeting the eligibility criteria for our study. All of the articles were case reports and were retrospective in nature (Tables 2-4).

3.2. Case Presentation

Case 1. This fifteen-year-old male known for HME presented with left hip pain with prolonged walking and sporting activities. He underwent multiple previous surgeries (left tibia, right distal femur, and upper extremities) for excision of osteochrondromas. On examination, a Trendelenburg gait was noted. The ROM was restricted in terms of hip abduction and flexion. Pelvic radiographs showed left hip dysplasia (center edge angle (CEA) of 18 degrees) and left femur neck osteochondroma causing left hip subluxation (Figures 1(a) and 1(b)). The surgical procedure was planned aiming to prevent further hip subluxation, relieve his symptoms, and to reduce the risk of osteoarthritis of the left hip in the future. The treating surgeon (N.S) has performed a left hip Bernese periacetabular osteotomy and femoral neck osteoplasty with partial excision of the osteochondroma through a modified Smith-Peterson approach (Figures 1(c) and 1(d)). The patient was kept nonweight bearing on the left lower extremity for 6 weeks and ROM exercises were initiated. At one-year follow-up, the ROM improved significantly and the patient reported no pain. Nevertheless, he had discomfort around the surgical site secondary to a prominent left iliac screw (Figure 1(e)). Therefore, this screw was removed in the operating room. At eighteen months of follow-up, the patient had a normal gait and no associated pain. He has returned to all sports including recreational soccer. The radiographs show good femoral head coverage (CEA = 33 degrees) (Figures 1(f) and 1(g)).

Case 2. This four-year-old female was referred to the authors' center for a recent diagnosis of HME. On her first visit, she had no complaints and her examination was unremarkable apart from palpable osteochondromas in the upper extremities and distal femora. Radiographs revealed a left femoral neck osteochondroma with bilateral coxa valga (left > right), a left dysplastic hip (CEA 7 degrees), and left hip subluxation (Figure 2(a)). At one year of follow-up, progressive left hip subluxation (CEA = 0) was noted (Figures 2(b) and 2(c)). Consequently, a left femoral varus derotational osteotomy with partial excision of the osteochondroma was performed by the treating surgeon (T.B) through the lateral approach. This was followed by application of a paediatric dynamic hip screw (DHS). The patient was able to walk with a normal gait without any associated pain at 1-year follow-up and by the 2nd year she was able to participate in sports. Her flexion and internal rotation improved significantly on subsequent follow-ups. However, external rotation and abduction of the left hip did not improve. Four years postoperatively, she was noted to have a restricted ROM in terms of hip abduction, external rotation, and flexion. Pelvic radiographs showed significant recurrence of the left hip osteochondroma with persistent left acetabular dysplasia and worsening left hip subluxation (Figure 2(d)). At this time she underwent a proximal femoral varus osteotomy and extensive excision of the left femoral neck osteochondroma through the lateral approach. In addition, a modified Dega osteotomy [28, 29] was performed through a Smith-Petersen approach. Postoperatively, the patient was placed in a left lower extremity hip spica cast and remained nonweight bearing for six weeks. The cast was removed six weeks after surgery and physiotherapy was initiated. At ten months follow-up, she had persistent weakness of her abductors and hardware related pain over her left proximal femur. Pelvic radiographs showed good femoral head coverage (CEA 35 degrees) and a healed osteotomy (Figure 2(e)). However, partial osteonecrosis of the femoral head was noted. At one-year follow-up, her Trendelenburg gait persisted and she reported pain at the prominent hardware site. Her ROM and radiographs were unchanged from previous examination. At this time point, hardware removal was planned. At six months after removal, she was ambulating with a mild Trendelenburg. Her trochanteric pain was reported to be much better than before.

Case 3. This thirteen-year-old female known for HME was referred to our center for left groin pain with a locking sensation. She had undergone multiple previous surgeries in the lower extremities for excision of osteochondromas. On examination, she had limited flexion, abduction, and internal/external rotation. The radiographs showed bilateral acetabular dysplasia (CEA: left = -5 degrees/right = +10 degrees) with an increased left femoral neck width secondary to osteochondromas (Figure 3(a)). Magnetic resonance imaging showed a large sessile osteochondroma in the acetabular fossa (Figure 3(b)). The treating surgeon (M.L) has performed a left acetabular Shelf procedure and femoral neck osteoplasty through the anterior approach. The acetabular osteochondroma was not excised. Postoperatively, the patient was kept partial weight bearing for 6 weeks with ROM exercises as tolerated. At three-year follow-up, the patient reported no left hip pain and the ROM had improved significantly. Pelvic radiographs showed good femoral head coverage (CEA = 40 degrees) (Figure 3(c)).

4. Discussion

The presented cases have illustrated successful excision of femoral neck osteochondromas and treatment of acetabular dysplasia and poor femoral head coverage through three different surgical treatments. A strong relationship between HME and the occurrence of acetabular dysplasia has been reported in the literature [5]. It has been hypothesized that acetabular dysplasia occurs in HME secondary to biomechanical alterations in the hip joint. The osteochondromas can result in abnormal mechanical forces that may drive the dysplasia. It has also been hypothesized that coxa valga may contribute to the dysplasia [5, 26, 30]. There is no consensus in the current literature with respect to surgical treatment for hip osteochondromas when associated with acetabular dysplasia (Table 2). Malagon resected two femoral neck osteochondromas in two paediatric patients (8 and 9 years old) with acetabular dysplasia [5]. He also performed bilateral staged Chiari procedures along with varus femoral derotational osteotomies. Although satisfactory results were achieved, one patient had persisted hip pain and restricted ROM. Felix et al. resected bilateral femoral neck osteochondromas in a 12-year-old female patient who also had acetabular dysplasia. Bilateral staged resections, steel osteotomies, and proximal femoral varus osteotomies were performed through the posterior approach [10]. At 3 years of follow-up, no complications were reported. Shinozaki et al. resected a femoral neck osteochondroma in a 30-year-old male patient who had a dysplastic hip [16]. The authors resected the lesion through the anterior approach and posterior approach. A rotational osteotomy was also performed. At 6 weeks of follow-up, recurrence of hip subluxation was observed and the greater trochanter was transferred distally. Ofiram and Porat have reported a female patient (16 years old) who had an osteochondroma at the femoral neck (circumferential) and floor of acetabulum in association with acetabular dysplasia [9]. They excised the lesion through the anterior approach with intraoperative hip subluxation. No pelvic procedure was performed, and the patient remains asymptomatic at 3 years of follow-up. In conclusion, these case reports indicate that a combined approach of osteochondroma excision and pelvic osteotomy is feasible and tolerated well in the short term. One question that remains is whether or not early surgical excision of these lesions may prevent acetabular dysplasia. Jellicoe et al. [7] reported two paediatric patients (aged 9 and 11 years) with acetabular osteochondromas and acetabular dysplasia that were successfully treated with intraoperative excision of the lesions by surgically dislocating the hip. At 2 years of follow-up, although the patients had no symptoms, residual acetabular dysplasia and growth disturbance were found. The authors concluded that excision of osteochondromas appears not to prevent or improve acetabular dysplasia. Despite their conclusion, we still feel that early excision of the osteochondromas can prevent acetabular dysplasia when performed at young age. Theoretically speaking, if performed while the acetabulum still has significant remodelling potential, osteochondroma excision should affect acetabular development. Furthermore, acetabular dysplasia is often asymptomatic. Therefore, we strongly recommend a routine radiographic pelvic survey at the time of diagnosis of HME so that early detection of the osteochondroma can be made and treatment can be recommended. Unfortunately, there is no data available to recommend on the frequency of radiographic surveillance.

Osteochondromas can occur as solitary lesions in the proximal femur and these typically are not associated with acetabular dysplasia or coxa valga. However, many problems can arise from these lesions such as labral tears, nerve compression, hip dislocation, external snapping hip, and malignant transformation in 0.4-2% of patients [8, 13, 19, 20, 27]. A variety of surgical techniques have been reported in the literature for these solitary lesions without dysplasia (Table 3). The main concerns for surgical resection of femoral neck and peritrochanteric osteochondromas are exposure and femoral head vascularity. In our report (Case 2), we believe that the multiple surgeries around the hip might have put the femoral head blood supply at risk and contributed to the partial osteonecrosis. Siebenrock and Ganz have described the lateral approach to the hip with surgical hip dislocation to allow access and adequate exposure of the femoral neck while preserving the vascular supply [14]. They presented four adult patients with successful resection of femoral neck osteochondromas located in posterior, inferior, and anterior regions of the femoral neck. Li et al. [6] have echoed these results utilizing the same technique for the resection of a posteromedial femoral neck osteochondroma in one paediatric case. Using both anterior and posterolateral approaches, Ramos-Pascua et al. have successfully excised femoral neck osteochondromas in 6 patients without dislocating or subluxating the hip [19]. These patients had good to excellent results based on the Musculoskeletal Tumour Society (MSTS) scale. Tschokanow [15] reported on two adult cases of lesser trochanter osteochondromas in which one patient had an excision through the anterior approach and was complicated by femoral vein laceration and sciatic nerve palsy. The second patient underwent a two-staged procedure (through anterior and lateral approach) with no reported complications. Recently, Feely and Kelly have proposed the use of hip arthroscopy for excising small osteochondromas in the femoral neck [27]. Taken together, the literature review failed to conclude a uniform treatment for these lesions. Until further data is published, surgeons treating these lesions must carefully plan surgery such that a safe and adequate resection can be carried out in an effective manner utilizing the surgical approach they feel most comfortable with while paying particular attention to femoral head vascularity. In addition, the exact location of the lesion should be defined preoperatively to help develop a surgical plan and the use of intraoperative fluoroscopy can be helpful in localizing the lesion and in verifying adequate resection.

Few reports in the literature have described the occurrence of osteochondromas in the acetabulum. The majority of the reported cases underwent surgical hip dislocation/subluxation to excise the acetabular lesion (Table 4). The advantage of using the surgical dislocation approach is to gain full access to such lesions. Woodward et al. reported on two paediatric patients with acetabular and femoral neck osteochondromas excised through an anterior approach without the need for intraoperative hip dislocation [11]. Using hip arthroscopy, Bonnomet et al. successfully excised a small acetabular osteochondroma in an 11-year-old patient with HME [17]. In our report (Case 3), we did not excise the acetabular osteochondroma as it was large and sessile. Surgical excision of such large sessile lesions will result in significant acetabular cartilage and bone deficiency. Therefore, we chose to leave the acetabular lesion and treat the dysplasia by performing a Shelf augmentation procedure and excision of the femoral neck osteochondroma. Preoperative hinge abduction and the questionable quality of the remaining cartilage made periacetabular rotational osteotomy a suboptimal option.

In conclusion, the literature review failed to conclude a uniform treatment for patients with hip joint osteochondromas with or without hip dysplasia. The three reported cases illustrate the successful excision of femoral neck osteochondromas and treatment of acetabular dysplasia through three different surgical treatments. In HME patients, we believe that early excision of osteochondromas can prevent the occurrence of acetabular dysplasia. Therefore, we recommend a routine radiographic pelvic survey in HME patients at the time of diagnosis for early detection of osteochondromas in the hip. Our results suggest the need for a multi-institutional prospective study for the natural history of hip pain and arthrosis and the surgical treatment of hip joint osteochondromas and also for determining the frequency of radiographic pelvic surveys in HME patients.

http://dx.doi.org/10.1155/2014/180254

Conflict of Interests

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this paper. The authors declare that there is no conflict of interests regarding the publication of this paper.

References

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[26] D. E. Porter, M. K. Benson, and G. A. Hosney, "The hip in hereditary multiple exostoses," The Journal of Bone and Joint Surgery. British, vol. 83, no. 7, pp. 988-995, 2001.

[27] B. Feeley and B. Kelly, "Arthroscopic management of an intraarticular osteochondroma of the hip," Orthopedic Reviews, vol. 1, no. 1, article e2, 2009.

[28] A. Al-Ghamdi, J. S. Rendon, F. Al-Faya, N. Saran, T. Benaroch, and R. C. Hamdy, "Dega osteotomy for the correction of acetabular dysplasia of the hip: a radiographic review of 21 cases," Journal of Pediatric Orthopaedics, vol. 32, no. 2, pp. 113-120, 2012.

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Asim M. Makhdom, (1,2) Fan Jiang, (1) Reggie C. Hamdy, (1) Thierry E. Benaroch, (1) Martin Lavigne, (3) and Neil Saran (1)

(1) Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1529 Cedar Avenue, Montreal, QC, Canada H3G1A6

(2) Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia

(3) Division of Orthopaedic Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 Assomption Boulevard, Montreal, QC, Canada H1T 2M4

Correspondence should be addressed to Asim M. Makhdom; makhdomas@hotmail.com

Received 17 January 2014; Accepted 23 March 2014; Published 20 May 2014

Academic Editor: Christian Bach

TABLE 1: Basic demographics and clinical data of three patients
included in this report.

          Age
Patient   years   Gender   Presentation      Loss of range of motion

Case 1    15      Male     Left hip pain     Left hip: Flexion:
                           with prolonged    30[degrees] Abduction:
                           activities.       20[degrees]

Case 2    4       Female   Difficulty with   Left hip: Internal
                           movement of       rotation: 10[degrees]
                           left hip noted    External rotation:
                           by patient's      15[degrees] Flexion:
                           mother.           20[degrees] Abduction:
                                             30[degrees]

Case 3    13      Female   Left hip pain     Left hip: Internal
                           with activity     rotation: 15[degrees]
                           and sensation     External rotation:
                           of locking.       10[degrees] Abduction:
                                             20[degrees]

Patient   Radiographic finding        Location of osteochondroma

Case 1    Left hip subluxation        Anterior femoral neck.
          secondary to femoral neck
          osteochondroma and
          acetabular dysplasia.

Case 2    (1) Left hip subluxation    Medial femoral neck and
          secondary to femoral neck   posterior intertrochanteric
          osteochondroma and          region.
          acetabular dysplasia.
          (2) Bilateral coxa valga.

Case 3    Left hip subluxation        Acetabular fossa and
          secondary to femoral neck,  anterior femoral neck.
          acetabular osteochondroma,
          and acetabular dysplasia.

Patient   Procedure(s)

Case 1    Excision of osteochondroma and the Bernese periacetabular
          osteotomy through a modified Smith-Peterson approach.

Case 2    At 4 years of age: proximal femur VDRO (1) with excision of
          osteochondroma and application of DHS (2) through lateral
          approach. At 8 years of age: left modified Dega osteotomy
          through anterior approach, removal of DHS, VDRO (1), and
          application of LCP (3) through lateral approach. At 9 years
          of age: removal of LCP.

Case 3    Excision of the femoral neck osteochondroma and Shelf
          procedure through anterior approach.

(1) Varus derotational osteotomy. (2) Dynamic hip screw. (3) Locking
compression plate.

TABLE 2: Literature review. Surgical treatments for hip
osteochondroma with acetabular dysplasia in previous studies.

                  Number
Author and          of
date             patients    Age    Gender   Location of the lesion

Malagon 2001       Two      Nine     Male    Medial femoral
[5]                         years            neck.

                            Eight    Male    Femur neck (the exact
                            years            location is not
                                             specified).

Felix et al.,      One       12     Female   femoral neck.
2000 [10]                   years

Shinozaki et       One       30      Male    Femoral neck
al., 1998 [16]              years            (the exact location is
                                             not specified).

Jellicoe et        Two      Nine    Female   Circumferential
al., 2009 [7]               years            femoral neck
                                             and floor of
                                             acetabulum.
                             11      Male    Cotyloid foramen.
                            years

Ofiram and         One       16     Female   Circumferential
Porat, 2004                 years            at the femoral
[9]                                          neck and also at
                                             the acetabular
                                             floor.

                  Number
Author and          of
date             patients    Age    Procedure

Malagon 2001       Two      Nine    (1) Right femoral varus
[5]                         years   osteotomy.
                                    (2) Bilateral staged Chiari
                                    procedures.

                            Eight   Bilateral proximal varus femur
                            years   osteotomy.

Felix et al.,      One       12     (1) Bilateral staged excision
2000 [10]                   years   through the posterior
                                    approach and VDRO (2).
                                    (2) Bilateral staged steel
                                    osteotomy.

Shinozaki et       One       30     Excision through the anterior
al., 1998 [16]              years   iliofemoral and posterior
                                    approach. Rotational acetabular
                                    osteotomy was performed.

Jellicoe et        Two      Nine    Excision through anterolateral
al., 2009 [7]               years   approach and surgical hip
                                    dislocation. No pelvic
                                    osteotomy was performed.

                             11     Excision through
                            years   transtrochanteric approach and
                                    surgical hip dislocation. No
                                    pelvic osteotomy was performed.

Ofiram and         One       16     Excision through
Porat, 2004                 years   Smith-Peterson approach and
[9]                                 intraoperative hip
                                    subluxation. No pelvic
                                    osteotomy was performed.

                  Number
Author and          of              Follow-up
date             patients    Age      period     Complications

Malagon 2001       Two      Nine                 Persistent hip pain
[5]                         years   Four years   and limited ROM (1).

                            Eight      Not       Not specified.
                            years   specified

Felix et al.,      One       12     Two years    Not reported.
2000 [10]                   years

Shinozaki et       One       30     Two years    Recurrence of
al., 1998 [16]              years                subluxation at 6
                                                 weeks after surgery.
                                                 Greater trochanter
                                                 distal transfer was
                                                 then performed.

Jellicoe et        Two      Nine    Two years    Not reported.
al., 2009 [7]               years

                             11       Three
                            years     years

Ofiram and         One       16       Three      Not reported.
Porat, 2004                 years     years
[9]

TABLE 3: Literature review. Surgical treatments for solitary proximal
femoral osteochondroma in previous studies.

                     Number     Age
                       of       in              Location of the
Author and date     patients   years   Gender   lesion

Yu et al.,            One       39      Male    Posterior FN (1)
2010 [13]

Siebenrock and        Four      26      Male    (1) Posterior
Ganz, 2002 [14]                 30     Female   inferior FN
                                20      Male    (2) Anterior,
                                39     Female   inferior, and
                                                posterior FN
                                                (3) Anteroinferior FN
                                                (4) Inferior FN

Tschokanow,           Two       33      Male    Lesser trochanter
1969 [15]                       36      Male    Lesser trochanter

Feeley and Kelly,     One       37     Female   Anterior FN
2009 [27]

Hussain et al.,       One       24      Male    Posterior FN
2010 [25]

Ramos-Pascua et       Six       20      Male    Medial FN
al., 2012 [19]                  45      Male    Anterior FN
                                50      Male    Medial FN
                                66     Female   Medial FN
                                28     Female   Anterior FN
                                29      Male    Anterior FN

Li et al.,            One       11      Male    Medial and posterior
2012 [6]                                        FN

Jones and             One       18              Posteroinferior FN
Kinninmonth,
2005 [8]

Liu et al.,           One       Six     Male    Posterior FN
2010 [23]

Learmonth and         One       13     Female   At the femoral
Raymakers,                                      epiphyseal plate
1993 [12]

Magid et al.,         One       14     Female   FN (exact location is
1996 [24]                                       not specified)

Muzaffar et al.,      One       22     Female   Base of FN
2012 [18]

Author and date     Procedure

Yu et al.,          Excision through a posterior approach
2010 [13]

Siebenrock and      Excision through lateral approach and digastric
Ganz, 2002 [14]     trochanteric osteotomy followed by
                    (i) surgical hip dislocation in two patients,
                    (ii) hip subluxation in the other two patients

Tschokanow,         Anterior approach
1969 [15]           Anterior and lateral approach (staged procedures
                    with 2-month interval)

Feeley and Kelly,   Excision by hip arthroscopy
2009 [27]

Hussain et al.,     Excision through posterolateral approach
2010 [25]

Ramos-Pascua et     Excision through anterior approach in 3 patients,
al., 2012 [19]      and by posterolateral approach on the other 3
                    patients.

Li et al.,          Excision through a surgical hip dislocation
2012 [6]            (digastric approach)

Jones and           Excision through posterior approach
Kinninmonth,
2005 [8]

Liu et al.,         Excision through lateral approach
2010 [23]

Learmonth and       Excision through Smith-Peterson approach
Raymakers,
1993 [12]

Magid et al.,       Excision through posterior approach
1996 [24]

Muzaffar et al.,    Excision through posterolateral approach
2012 [18]

                      Follow-up
Author and date        period       Complications

Yu et al.,            22 months     Not reported.
2010 [13]

Siebenrock and       18-48 month    One patient had intermittent pain
Ganz, 2002 [14]                     in greater trochanter area on
                                    follow-ups.

Tschokanow,         Not specified   Femoral vein injury and sciatic
1969 [15]                           nerve palsy. Postoperative wound
                                    infection. Not reported.

Feeley and Kelly,    Six months     Not reported.
2009 [27]

Hussain et al.,     Seven months    Persisted pain due to FA (2)
2010 [25]                           impingement.

Ramos-Pascua et       From 2 to     One patient had basicervical
al., 2012 [19]        20 years      fracture and was treated
                                    successfully with no sequelae.

Li et al.,           Seven years    Not reported.
2012 [6]

Jones and           Not specified   ?
Kinninmonth,
2005 [8]

Liu et al.,          Four years     Not reported.
2010 [23]

Learmonth and       Not specified   ?
Raymakers,
1993 [12]

Magid et al.,        Nine months    Non reported
1996 [24]

Muzaffar et al.,    Not specified   ?
2012 [18]

(1) Femoral neck. (2) Femoroacetabular.

TABLE 4: Literature review. Surgical treatments for acetabular
osteochondroma in previous studies.

                Number
Author and        of
date           patients    Age      Gender     Location of the lesion

Ofiram and        One      16     Female (1)   Circumferential at the
Porat,                    years                femoral neck also at
2004 [9]                                       the acetabular floor

Woodward          Two     Three      Male      Base of acetabulum and
et al.,                   years                femoral neck
1999 [11]
                           11       Female     Inferomedial
                          years                acetabulum and
                                               anterior femoral neck

Bonnomet          Two      11        Male      Acetabular fossa
et al.,                   years
2001 [17]
                          Nine      Female     Acetabular fossa
                          years

Ettl et al.,      Two     Eight      Male      Acetabular floor
2006 [22]                 years

Jellicoe          Two     Nine    Female (1)   Circumferential
et al.,                   years                femoral neck and floor
2009 [7]                                       of acetabulum

                           11      Male (1)    Cotyloid foramen
                          years

Bracqet al.,      One     Three     Female     Base of the acetabulum
1987 [21]                 years

               Number
Author and        of
date           patients    Age    Procedure

Ofiram and        One      16     Excision through Smith-Peterson
Porat,                    years   approach and intraoperative hip
2004 [9]                          subluxation.

Woodward          Two     Three   Excision through anterior approach
et al.,                   years   followed by hip spica for 6 weeks.
1999 [11]
                           11     Excision through anterior approach.
                          years

Bonnomet          Two      11     Excision by hip arthroscopy
et al.,                   years   technique.
2001 [17]
                          Nine    Excision by hip arthroscopy
                          years   technique.

Ettl et al.,      Two     Eight   Excision though anterolateral
2006 [22]                 years   approach and hip subluxation. The
                                  patient also had VDRO (2) to
                                  correct the coxa valga.

Jellicoe          Two     Nine    Excision through anterolateral
et al.,                   years   approach and surgical hip
2009 [7]                          dislocation.

                           11     Excision through transtrochanteric
                          years   approach and surgical hip
                                  dislocation.

Bracqet al.,      One     Three   Excision through the Elueter
1987 [21]                 years   anterior approach and surgical hip
                                  dislocation.

               Number
Author and        of
date           patients    Age    Follow-up period   Complications

Ofiram and        One      16       Three years      Not reported
Porat,                    years
2004 [9]

Woodward          Two     Three        Three         Not reported
et al.,                   years        months
1999 [11]
                           11        14 months
                          years

Bonnomet          Two      11       Three years      Not reported
et al.,                   years
2001 [17]
                          Nine       Two years
                          years

Ettl et al.,      Two     Eight
2006 [22]                 years      Two years       Not reported

Jellicoe          Two     Nine       Two years       Not reported
et al.,                   years
2009 [7]
                           11       Three years

                          years

Bracqet al.,      One     Three     Three years      Not reported
1987 [21]                 years

(1) These patients have had associated acetabular dysplasia in the
affected hip. (2) Varus derotational osteotomy.
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Author:Makhdom, Asim M.; Jiang, Fan; Hamdy, Reggie C.; Benaroch, Thierry E.; Lavigne, Martin; Saran, Neil
Publication:Advances in Orthopedics
Article Type:Report
Date:Jan 1, 2014
Words:5106
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