PMC4054980_01
(a) Preoperative anteroposterior pelvic radiograph. (b) Preoperative false profile view showing poor anterior femoral head coverage. (c) Intraoperative images showing the location of the femoral head (arrow A) and the femoral neck osteochondroma (arrow B). (d) Postpartial excision of osteochondroma (arrow B) and the location of the femoral head (arrow A). (e) Anteroposterior pelvic radiograph at 1-year follow-up. (f) Anteroposterior pelvic radiograph at 18 months of follow-up. (g) False profile pelvic radiograph at 18 months of follow-up showing improved anterior coverage.
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fig1
Pelvic radiographs showed left hip dysplasia (center edge angle (CEA) of 18 degrees) and left femur neck osteochondroma causing left hip subluxation (Figures 1(a) and 1(b)). The treating surgeon (N.S) has performed a left hip Bernese periacetabular osteotomy and femoral neck osteoplasty with partial excision of the osteochondroma through a modified Smith-Peterson approach (Figures 1(c) and 1(d)). Nevertheless, he had discomfort around the surgical site secondary to a prominent left iliac screw (Figure 1(e)). The radiographs show good femoral head coverage (CEA = 33 degrees) (Figures 1(f) and 1(g)).
PMC4054980_02
(a) Anteroposterior pelvic radiograph at initial presentation. (b) Anteroposterior pelvic radiograph and (c) Computed tomography of the pelvis at one-year follow-up. (d) Anteroposterior pelvic radiograph 4 years after left femoral varus derotational osteotomy (VDRO) with partial excision of the osteochondroma. (e) Anteroposterior pelvic radiograph ten months after performing the second VDRO, modified Dega osteotomy, and extensive excision of femoral neck osteochondroma. Partial left femoral head necrosis is also noted.
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Radiographs revealed a left femoral neck osteochondroma with bilateral coxa valga (left > right), a left dysplastic hip (CEA 7 degrees), and left hip subluxation (Figure 2(a)). At one year of follow-up, progressive left hip subluxation (CEA = 0) was noted (Figures 2(b) and 2(c)). Pelvic radiographs showed significant recurrence of the left hip osteochondroma with persistent left acetabular dysplasia and worsening left hip subluxation (Figure 2(d)). Pelvic radiographs showed good femoral head coverage (CEA 35 degrees) and a healed osteotomy (Figure 2(e)).
PMC4054980_03
(a) Anteroposterior pelvic radiograph at initial presentation. (b) Magnetic resonance imaging showing a large sessile osteochondroma within the left acetabular fossa. (c) Anteroposterior radiograph of the pelvis 3 years after the left acetabular Shelf procedure and femoral neck osteoplasty.
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The radiographs showed bilateral acetabular dysplasia (CEA: left = -5 degrees/right = +10 degrees) with an increased left femoral neck width secondary to osteochondromas (Figure 3(a)). Magnetic resonance imaging showed a large sessile osteochondroma in the acetabular fossa (Figure 3(b)). Pelvic radiographs showed good femoral head coverage (CEA = 40 degrees) (Figure 3(c)).