PMC5343235_01
Preoperative anteroposterior (a) and frog-leg radiographs (b) of the right hip in Case 1 demonstrate developmental dysplasia of the hip and the presence of a cross-over sign. Preoperative coronal FIESTA 3D (c), coronal T1-weighted fat-saturated (d), and sagittal proton-density fat-saturated (e, f) magnetic resonance sequences with intra-articular contrast reveal the tumor, a 2.5 cm intermediate to low signal focus within the inferomedial aspect of the right hip joint, in addition to a complex tear of the right anterior and anterosuperior acetabular labrum. A = anterior; P = posterior.
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fig1
Initial radiographs revealed right hip dysplasia and stigmata of femoroacetabular impingement (FAI), with the right hip exhibiting a cross-over sign (Figures 1(a) and 1(b)). In addition, there was a complex tear of the anterior and anterosuperior acetabular labrum (Figure 1).
Gross pathology of PVNS from Case 1 (a, b), excised en bloc from the posterior-inferior aspect of the capsule and confirmed to be PVNS on formal pathological analysis.
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fig2
The nodular mass and stalk were excised sharply en bloc (Figure 2) and sent for formal pathologic analysis, which confirmed the presence of PVNS.
PMC5343235_02
Preoperative anteroposterior (a) and frog-leg radiographs (b) of the left hip in Case 2 demonstrate a cam deformity. Preoperative coronal T2-weighted fat-saturated (c), axial T2-weighted (d), and sagittal T2-weighted fat-saturated (e, f) magnetic resonance sequences with intravenous contrast reveal a multilobulated low signal lesion (arrow in d) measuring approximately 4.0 x 1.1 x 3.4 cm within the posterior/inferior aspect of the hip joint, with an associated large joint effusion. A = anterior; P = posterior.
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fig3
Outside hospital radiographs were largely unremarkable but did reveal a left-sided cam deformity (Figure 3). A MRI revealed a multilobulated lesion measuring approximately 4.0 x 1.1 x 3.4 cm within the posterior/inferior aspect of the hip joint, with an associated large joint effusion (Figure 3).
Intraoperative image of a surgical dislocation of the left hip in Case 2, which allowed for adequate exposure to visualize and excise the mass (a). Gross pathology of the tumor from the same case is depicted (b), excised en bloc from the posterior-inferior aspect of the capsule and confirmed to be PVNS on formal pathological analysis.
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fig4
With the patient under general anesthesia, a surgical dislocation of the left hip was performed using the technique described by Ganz et al. (Figure 4). The synovial mass was excised en bloc down to the stalk (Figure 4).