Pachore Javahir A, Shah Vikram I, Jhunjhunwalla H R, Babu Clint, Parameswaran Apurve, Eachempati Krishna Kiran
Department of Orthopaedics, Shalby Hospital, Ahmedabad, Gujarat, India.
Department of Orthopaedics, Bombay Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2025 Jul;15(7):23-27. doi: 10.13107/jocr.2025.v15.i07.5754.
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.
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.
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.
骨动脉瘤性骨囊肿的治疗方法随时间不断演变，重点已从手术转向侵入性较小的治疗方式。直到最近，刮除术（无论是否植骨）一直被视为首选手术，但复发率较高。复发性骨动脉瘤性骨囊肿的治疗具有挑战性，尤其是在存在病理性骨折的情况下。关于股骨近端骨动脉瘤性骨囊肿的全髋关节置换术的文献很少。
一名27岁男性于1999年因右股骨近端骨动脉瘤性骨囊肿接受了扩大刮除术和植骨术。术后17个月，他因骨动脉瘤性骨囊肿复发及右股骨颈病理性骨折就诊于急诊科。他接受了陶瓷对陶瓷关节的非骨水泥型全髋关节置换术。术中，从股骨近端清除了所有残留的肿瘤内膜。在固定最终假体后，实现了髋关节的稳定复位。进行了增强的后方软组织修复。术后六周允许部分负重，此后完全负重。术后24年，患者的Harris髋关节评分为97分，无骨溶解或假体松动的影像学证据。
骨动脉瘤性骨囊肿主要影响年轻人。因此，其初始治疗应侧重于保留关节的方式。然而，对于怀疑有复发性骨动脉瘤性骨囊肿且伴有股骨颈病理性骨折、骨质大量丢失和残余骨质质量差的患者，必须考虑全髋关节置换术。
