Twenty-Four-Year Follow-up of Successful Total Hip Arthroplasty for Recurrent Proximal Femoral Aneurysmal Bone Cyst with a Pathologic Fracture Following Extended Curettage and Bone Grafting: A Case Report.

INTRODUCTION

The approach to the management of aneurysmal bone cysts has evolved over time, with the focus shifting from surgery to less invasive therapeutic modalities. Curettage with or without bone grafting was considered the procedure of choice until recently but is associated with high recurrence rates. The management of recurrent aneurysmal bone cysts is challenging, especially in the presence of pathologic fractures. Scant literature is available on total hip arthroplasty for aneurysmal bone cysts of the proximal femur.

CASE REPORT

A 27-year-old man underwent extended curettage and bone grafting for an aneurysmal bone cyst of the right proximal femur in 1999. He presented to the emergency department 17 months after the surgery with a recurrence of the aneurysmal bone cyst and a pathologic fracture of the right femoral neck. He underwent cementless total hip arthroplasty with a ceramic-on-ceramic articulation. Intraoperatively, all residual tumor lining was cleared from the proximal femur. Following the fixation of the definitive prostheses, stable hip reduction was attained. Enhanced posterior soft tissue repair was performed. He was permitted partial weight-bearing for six weeks post-operatively, and full weight-bearing thereafter. At 24 years post-operatively, the patient had a Harris Hip Score of 97, with no radiologic evidence of osteolysis or component loosening.

CONCLUSION

Aneurysmal bone cysts primarily affect young individuals. Their initial treatment, therefore, should focus on joint-preserving modalities. However, total hip arthroplasty must be considered for suspected recurrent aneurysmal bone cysts with pathologic fractures of the neck of the femur in patients with extensive bone loss and poor-quality residual bone.