Detaillierte Beitrags-Information
| Beitragstitel | Unrecognized chondrosarcoma as a cause of total hip arthroplasty failure. A case series and review of the literature. |
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| Beitragscode | P036 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction According to the Swedish registry, total hip replacements (THR) were performed with 95% of excellent outcomes at 10 years follow-up . The most common THR indications were osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening was by far the primary indication to revision surgery. X-Ray are cost-efficient and most often sufficient to support surgical indication. Bone tumors and especially chondroid tumors are nonetheless difficult to specify on radiographs. Therfore the threshold to CT /MRI should be low. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most common location. If THR is performed in the setting of unrecognized CS, it will surely lead to early relapse and poor or even fatal outcome. We report three cases of unrecognized high grade CS in the setting of primary or revision THR and review the literature on this rare clinical presentation. Methode A systematic review on articles related to THR and bone tumors, published between 1980 and 2018 was performed on Pubmed, Embase, Medline Ovid SP and Web of Science, using the guidelines set in the PRISMA. Results Case series: three patients were referred to our sarcoma center after failure of THR due to unrecognized high-grade CS. All three cases presented with advanced staged disease, leading to a rapid fatal outcome. Looking at preoperative work-up, we could not identify radiological signs of either osteoarthritis, avascular necrosis of the femoral head, or aseptic loosening of the stem to support indication to primary or revision THR. Literature review: 58 papers were identified of which 12 met the inclusion criteria on the subject. They confirmed that primary or revision THR failure due to unrecognized CS is extremely rare, with only few case reports available in the review. Altogether, 13 cases of CS in the setting of THR were described in 11 papers. Outcome was generally unfavorable. Conclusions Before proceeding to THR primary or revision, diagnosis must be ascertained. Atypical presentation of a common pathology, like osteoarthritis, avascular necrosis or aseptic loosening of a THR, should raise suspicion for another cause for symptoms, and additional work-up be performed. As our cases dramatically demonstrate, unrecognized or inadequately managed bone or soft tissue sarcoma may lead to poor or even fatal outcome. In doubtful cases, a second opinion should be asked in a multidisciplinary reference center. |