Arthroscopic treatment for femoral neck enchondroma: case report

Abstract

Introduction/objectives: Enchondromas are benign hyaline cartilage tumours that radiographically present with irregular intra lesional calcification. Surgical treatment is indicated when there is evolution of the lesion or when it becomes symptomatic. It consists on lesion curettage with or without bone grafting and usually it's curative. Hip arthroscopy allows getting good visualization of the central and peripheral compartment of the hip, thereby decreasing the morbidity resulting from the surgery. Method(s): A 50 years old female patient was referred with left hip pain. X-Ray and MRI revealed a chondroid lesion located in the medial aspect of the femoral neck with a diameter of 2.8 cm without cortex invasion. After initial treatment with NSAID's of 6 weeks the complaints persisted. The patient was proposed for arthroscopic curettage of the lesion. She underwent hip arthroscopy using the outinside technique (peripheral access first after a T shaped capsulotomy) for lesion curettage. The femoral neck was visualized after a "T" capsulotomy. Curettage of the lesion was performed under fluoroscopic control. After the enchondroma excision, bone graft was used to fill the defect. Result(s): After 3 months, the outcome is excellent. She reported a WOMAC score of 85 (63.3 pre-op), an MHHS of 87 (69 pre-op) and a VAS for pain score of 3 (8 pre-op). No radiographic signs of osteonecrosis are observed. Conclusion(s): Hip arthroscopy is a therapeutic option in dealing with femoral neck lesions, allowing its removal without recourse to an arthrotomy, thereby minimizing the surgical morbidity and improving the recovery of these patients.