Zamora Tomas, Gehrung Antonia, Klaber Ianiv, Carmona Maximiliano, Schweitzer Daniel, Botello Eduardo
Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
Eur J Orthop Surg Traumatol. 2025 Mar 21;35(1):129. doi: 10.1007/s00590-025-04258-9.
Bone tumors around the hip pose significant surgical challenges. While surgical dislocation with a trochanteric flip osteotomy through a posterior approach is commonly used, it is associated with known complications. This study is the first to report outcomes using surgical hip dislocation without a trochanteric osteotomy for this purpose. We evaluated early to long-term outcomes of this approach and compared results between patients undergoing extensive curettage with adjuvants and those undergoing simple excision.
Sixteen patients (18 hips) with benign or intermediate bone and synovial tumors were treated using surgical dislocation without a trochanteric flip osteotomy. Patients had a minimum follow-up of 12 months (median 3.6 years, range 1-11 years). Outcomes included local recurrence, complications, functionality, and quality of life (QoL) assessed with SF-12 (mental and physical components), HOOS, TESS, and MSTS scores. Comparative analysis was performed between extensive curettage with adjuvancy and simple excision. Results All procedures were completed successfully without any local recurrences or significant complications. Patients had a median hospital stay of 3 days (ranging from 1 to 4 days), and the median follow-up duration was 3.6 years (ranging from 1 to 13 years). The mean SF-12 physical and mental health scores were 51 and 42, respectively. Additionally, the scores for HOOS, MSTS, and TESS were 74, 77%, and 86%, respectively. One patient (6%) developed osteoarthritis, while three (17%) experienced lateral hip pain managed conservatively. No significant differences were found in complications, functionality, or QoL between the extensive curettage and simple excision groups.
Surgical dislocation of the hip without trochanteric osteotomy is a safe and effective alternative for excising tumors around the hip. It provides excellent exposure and achieves successful oncologic and functional outcomes. Patients requiring extensive curettage with adjuvants achieve comparable results to those treated with simple excision, offering a viable and novel surgical option for challenging cases.
髋关节周围的骨肿瘤给手术带来了重大挑战。虽然通过后路进行转子翻转截骨的手术脱位是常用方法，但它存在一些已知并发症。本研究首次报告了为此目的使用不进行转子截骨的手术性髋关节脱位的结果。我们评估了该方法的早期至长期结果，并比较了接受广泛刮除加辅助治疗的患者与接受单纯切除的患者的结果。
16例（18髋）患有良性或中间性骨及滑膜肿瘤的患者接受了不进行转子翻转截骨的手术脱位治疗。患者的最短随访时间为12个月（中位时间3.6年，范围1 - 11年）。结果包括局部复发、并发症、功能以及使用SF - 12（心理和生理成分）、HOOS、TESS和MSTS评分评估的生活质量（QoL）。对广泛刮除加辅助治疗和单纯切除进行了比较分析。结果所有手术均成功完成，无局部复发或重大并发症。患者的中位住院时间为3天（范围1至4天），中位随访时间为3.6年（范围1至13年）。SF - 12身体和心理健康评分的平均值分别为51和42。此外，HOOS、MSTS和TESS的评分分别为74、77%和86%。1例患者（6%）发生骨关节炎，3例（17%）出现经保守治疗的髋关节外侧疼痛。广泛刮除组和单纯切除组在并发症、功能或生活质量方面未发现显著差异。
不进行转子截骨的手术性髋关节脱位是切除髋关节周围肿瘤的一种安全有效的替代方法。它提供了良好的暴露，并取得了成功的肿瘤学和功能结果。需要广泛刮除加辅助治疗的患者与接受单纯切除的患者取得了可比的结果，为具有挑战性的病例提供了一种可行且新颖的手术选择。
