Birsel Olgar, Aslan Lercan, Eren İlker, Deveci Mehmet Ali, Şimşek Aykın
Department of Orthopaedics and Traumatology, Koç University School of Medicine, Istanbul, Türkiye.
Acta Orthop Traumatol Turc. 2025 Mar 17;59(1):58-62. doi: 10.5152/j.aott.2025.24021.
This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty.
A retrospective review was conducted on medical records, operative notes, and histopathology reports of patients who underwent hip arthroplasty between 2016 and 2024. Patients without pathological evaluation or with known metastases were excluded. The study included patients with hip osteoarthritis undergoing total hip arthroplasty and those with femoral neck fractures undergoing bipolar hemiarthroplasty. Preoperative diagnoses, comorbidities, and operative and histopathological findings were analyzed.
The study included 193 patients with femoral neck fractures (mean age: 76.8 years, age range=60 - 98 years) and 257 with osteoarthritis (mean age: 60.4 years, age range= 23 - 88). After excluding 22 femoral neck fracture and 90 osteoarthritis patients, 36 patients in the fracture group and 18 in the osteoarthritis group had a history of malignancy, with 10 and 2 patients, respectively, having known metastases. Incidental metastatic bone disease was identified in four femoral neck fracture patients, while no neoplastic findings were detected in the osteoarthritis group.
Routine pathological examination of femoral heads is particularly relevant in femoral neck fracture cases, where the risk of detecting metastatic disease is higher. While thorough preoperative assessments and meticulous intraoperative evaluations aid diagnosis, the decision to submit specimens for pathology should be guided by the surgeon's clinical judgment and patient-specific factors.
Level III, Diagnostic Study.
本研究旨在评估在接受择期和急诊髋关节置换术的患者中，对股骨头进行常规病理检查以检测偶然发生的转移性骨病的必要性。
对2016年至2024年期间接受髋关节置换术的患者的病历、手术记录和组织病理学报告进行回顾性分析。排除未进行病理评估或已知有转移的患者。该研究包括接受全髋关节置换术的髋骨关节炎患者以及接受双极半髋关节置换术的股骨颈骨折患者。分析术前诊断、合并症以及手术和组织病理学检查结果。
该研究纳入了193例股骨颈骨折患者（平均年龄：76.8岁，年龄范围=60 - 98岁）和257例骨关节炎患者（平均年龄：60.4岁，年龄范围=23 - 88岁）。在排除22例股骨颈骨折患者和90例骨关节炎患者后，骨折组有36例患者和骨关节炎组有18例患者有恶性肿瘤病史，分别有10例和2例已知有转移。在4例股骨颈骨折患者中发现了偶然发生的转移性骨病，而在骨关节炎组未检测到肿瘤性病变。
对股骨头进行常规病理检查在股骨颈骨折病例中尤为重要，因为在这些病例中检测到转移性疾病的风险较高。虽然全面的术前评估和细致的术中评估有助于诊断，但是否提交标本进行病理检查的决定应由外科医生的临床判断和患者的具体因素来指导。
III级，诊断性研究。
