Hip Pelvis.  2015 Mar;27(1):43-48. 10.5371/hp.2015.27.1.43.

Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report

• Jung HT
• Hwang DS
• Jeon YS
• Kim PS

• KMID: 2156019
• DOI: http://doi.org/10.5371/hp.2015.27.1.43

Abstract

A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.

Keyword

Hip; Arthroscopy; Osteochondroma

MeSH Terms

Acetabulum
Arthroscopy
Biopsy
Femoracetabular Impingement
Femur Neck
Follow-Up Studies
Hip
Hip Joint*
Humans
Male
Osteochondroma*
Physical Examination
Recurrence

Figure

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  Fig. 1 Frog-leg lateral view. The bony lesion was found at posteromedial portion of right femoral neck.

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  Fig. 2 (A) Preoperative computed tomography (CT). Bony protuberance was located just above lesser trochanter. (B) Preoperative CT. Bony protuberance was located just above lesser trochanter.

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  Fig. 3 Intraarticular bony lesion was suggestive of osteochondroma with cartilaginous cap in magnetic resonance arthrography image.

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  Fig. 4 (A) Arthroscopic finding of acetabular labral tear (arrow) at anterosuperior portion of acetabulum. Anterolateral and anterior portal were used as viewing and working portal, each. (B) Acetabuloplasty using arthroscopic spherical burr (Linvatec, Largo, FL, USA) for correction of pincer femoroacetabular impingement. (C) Acetabular labral repair with two bioabsorbable suture anchors (Bioraptor; Smith & Nephew, Andover, MA, USA).

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  Fig. 5 Arthroscopic finding of osteochondroma with cartilaginous cap (arrow) at posteromedial portion of femoral neck. FN: femoral neck, OC: osteochondroma.

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  Fig. 6 (A) Postoperative simple radiography. The bony mass was removed successfully. (B) Postoperative 3 dimensional computed tomography image. Complete resection of osteochondroma was identified and degree of osteoplasty was evaluated postoperatively.

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  Fig. 7 The cartilagious cap was identified in biopsy and the cap has a smooth round surface of a pathologic finding of osteochondroma (hematoxylin and eosin stain, ×40).

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  Fig. 8 (A) Hip anteroposterior simple radiopraphy at postoperative 1 year. Posteromedial cortex of the femoral neck was reformed and any bony recurrence was not shown. (B) Hip frog leg lateral radiography at postoperative 1 year.

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  Fig. 9 (A) In postoperative axial image, leakage of arthroscopic fluid and air bubbles were shown around iliopsoas muscle. (B) In coronal computed tomography image, air bubbles were found along iliopsoas muscle.

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