Unrecognized Chondrosarcoma as a Cause of Total Hip Arthroplasty Failure

Laurent Mustaki, MD; Patrick Goetti, MD; Nicolas Gallusser, MD; Boris Morattel, MD; Hannes A. Rüdiger, MD; Stéphane Cherix, MD

Arthroplasty Today (Feb 2021)

Unrecognized Chondrosarcoma as a Cause of Total Hip Arthroplasty Failure

Laurent Mustaki, MD,
Patrick Goetti, MD,
Nicolas Gallusser, MD,
Boris Morattel, MD,
Hannes A. Rüdiger, MD,
Stéphane Cherix, MD

Affiliations

Laurent Mustaki, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Corresponding author. Department of orthopedics and traumatology, Lausanne University Hospital - CHUV, Av. Pierre-Decker 4, 1011 Lausanne, Switzerland. Tel.: +41 79 556 79 52.
Patrick Goetti, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Nicolas Gallusser, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Boris Morattel, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Hannes A. Rüdiger, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Department of Orthopeadics, Schulthess Clinic, Zürich, Switzerland
Stéphane Cherix, MD: Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

Journal volume & issue: Vol. 7
pp. 84 – 90

Abstract

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Background: Total hip arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. The most frequent THA indications are osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening is the most common indication to revision surgery. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most prevalent location. Wide resection is the treatment of choice.We report 3 cases of unrecognized high-grade CS in the setting of primary or revision THA and reviewed the literature on this rare clinical presentation. Methods: A systematic literature review on CS in the setting of THA, published between 1980 and 2020, was performed on PubMed, Embase, Medline, Ovid SP, and Web of Science, using the guidelines set in the Preferred Reporting Items for Systematic Reviews and Mata-analyses (PRISMA). Results: Case series: Three patients were referred to our sarcoma center after failure of THA due to unrecognized high-grade CS. All 3 had rapid fatal outcome. Literature review: Fifty-nine articles were identified, of which 8 were included in the study. They confirmed that primary or revision THA failure due to unrecognized CS is extremely rare, with only few cases reported in the literature. Conclusions: Before proceeding to primary or revision arthroplasty, diagnosis must be ascertained. Atypical presentation of a common pathology, such as osteoarthritis, avascular necrosis, or aseptic loosening of an endoprosthesis, should raise suspicion for another cause to symptoms, and additional workup be performed. As our cases demonstrated, unrecognized or inadequately managed bone sarcoma may lead to poor or even fatal outcome.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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