Osteochondroma of the femoral neck.

Abstract

Osteochondromas of the femoral neck represent intraarticular lesions and are difficult to access for surgical resection, especially when located posteriorly. A versatile surgical approach with dislocation of the femoral head is described through which reliable resection of the osteochondroma can be done respecting the crucial blood supply to the femoral head, the deep branch of the medial femoral circumflex artery. Surgical femoral head dislocation offers the possibility of excellent visualization, circumferential access to the femoral neck, and complete intraarticular inspection. This approach has been used in four patients with osteochondroma of the femoral neck who presented with pain, restricted range of motion, and a limp. Femoroacetabular impingement of the bulky osteochondroma against the acetabular rim could be verified in all patients. In two patients labral lesions were found at the impingement site. All patients had prompt bleeding intraoperatively from a 2.0-mm drill hole of the femoral head after resection of the osteochondroma. There were no or minimal symptoms after a median followup of 34 months (range, 18-48 months) and no clinical or radiographic signs of avascular necrosis of the head.