PMC6754929_01
Preoperative AP pelvis X-ray showing femoral head osteolytic lesion (blue arrow).
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Radiographs showed an epiphyseal lytic lesion of the proximal femur with the involvement of the fovea (Figure 1).
T2 MRI views of the left hip: coronal view (a) and axial view (b) of the hip with joint effusion (orange arrows).
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An associated joint effusion was noted, as well as bone marrow edema (Figure 2).
CT-Scan axial view illustrating a 3.5 x 3.2 x 2 cm lesion with sclerotic borders and intralesional calcifications (blue arrow).
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A computerized tomography scan (CT-Scan) showed a well-defined lesion of 3.5 x 3.2 x 2 cm with sclerotic borders and intralesional calcifications suggestive of a chondroid-like matrix (Figure 3).
(a) Surgical view of the femoral head lesion following anterior hip dislocation. (b) Surgical view of the femoral head showing congruent graft surface with the radius of the host femoral head.
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The hip was carefully dislocated anteriorly (Figure 4(a)). The donor graft surface curvature was congruent with the radius of the host femoral head (Figure 4(b)).
(a) Immediate postoperative AP pelvis radiography showing the two 4.0 mm cannulated screws stabilizing the greater trochanter osteotomy. (b) Two-year postoperative AP X-ray showing good graft position without head collapse or degenerative changes, as well as heterotopic ossification at the tip and lateral to the greater trochanter (orange arrows). (c) Six-year postoperative AP X-ray showing femoral head inferior osteophyte with narrowing of the joint space (blue arrow). (d) Seven-year postoperative AP X-ray showing discrete progression of femoral head inferior osteophyte (blue arrow).
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Postoperative radiographs showed proper graft positioning and restoration of joint line congruity (Figure 5(a)). There was no tumor recurrence, no head collapse, and no degenerative changes (Figure 5(b)). On X-rays, there were minor degenerative changes with inferior femoral head osteophytes and joint space narrowing medially (Figure 5(c)). There was minor progression of previously described degenerative changes (Figure 5(d)).
Histopathological sections of the lesion: (a) intracellular calcification, (b) mononuclear cells with a characteristic pale cytoplasm, and (c) positive S100 immunolabeling within chondroblast cells.
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The pathologist confirmed the diagnosis of chondroblastoma on histopathological examination (see Figure 6).
Axial CT-Scan of the left hip: (a) 2 years postoperatively and (b) 6 years postoperatively.
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Radiographs and a CT-Scan confirmed proper graft incorporation (see Figure 7(a)). The osteoarticular allograft still looked intact on the CT-Scan images (Figure 7(b)).
Postoperative MRI of the left hip at 6 years: (a) T1 AP view and (b) T1 axial view of a well-integrated osteochondral graft.
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There were no signs of local recurrence in the femoral head (Figure 8).