CORR Insights^®: What Are the Results Using the Modified Trapdoor Procedure to Treat Chondroblastoma of the Femoral Head?

Excerpt

Chondroblastoma is a rare benign but aggressive bone lesion. It generally is treated with curettage of the lesion and reconstruction. Primary considerations in the management of these lesions include adjunctive local treatments and choosing the right surgical approach for lesions in difficult locations such as the femoral head; as we think about research on the problem, assessing functional outcomes also is important. The risk of local recurrence has been reported between 10% to 40% [6]. Use of adjuvant treatment with cryotherapy [3] or phenol [9] has been associated with a less than 10% risk of local recurrence [3, 9], while others have reported a low-risk of local recurrence (13%) with extended curettage alone [7]. Radiofrequency ablation has been proposed as a less invasive treatment with reported local recurrence in one of 17 patients [5] and zero out of 12 patients [2]. Surgical approach options for femoral head lesions include drilling along the femoral neck, hip joint arthrotomy with a trapdoor of the femoral neck or articular surface, and surgical hip dislocation as described by Ganz et al. [1]. Treatment via drilling along the femoral neck has been associated with an increased risk of local recurrence compared to a direct approach through the femoral neck or femoral head [4, 6, 9]. Xu et al. [9] reported no local recurrences among 14 patients treated with a modified trapdoor procedure of the articular surface. The functional outcome following treatment has been primarily reported on a descriptive basis without use of functional outcome measures. Xu et al. [9] also reported high functional results with the Musculoskeletal Tumor Society score, although this is not a patient-reported outcome measure. …