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Unrecognized Chondrosarcoma as a Cause of Total Hip Arthroplasty Failure
Laurent Mustaki1, Patrick Goetti1, Nicolas Gallusser1
1Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
Unrecognized high-grade chondrosarcoma (CS) can complicate total hip arthroplasty (THA), leading to poor outcomes. Early diagnosis and thorough workup are crucial to avoid fatal results in patients with atypical hip pain.
Area of Science:
- Orthopedic Surgery
- Oncology
- Radiology
Background:
- Total hip arthroplasty (THA) is a successful orthopedic procedure, commonly indicated for osteoarthritis and avascular necrosis.
- Symptomatic aseptic loosening is the primary reason for revision THA.
- Chondrosarcoma (CS), the most common adult bone sarcoma, frequently occurs in the proximal femur, requiring wide resection.
Purpose of the Study:
- To report three cases of unrecognized high-grade chondrosarcoma (CS) in patients undergoing primary or revision total hip arthroplasty (THA).
- To review the literature on this rare clinical presentation of CS associated with THA.
Main Methods:
- A systematic literature review was conducted on PubMed, Embase, Medline, Ovid SP, and Web of Science.
- The review focused on studies published between 1980 and 2020 concerning CS in the context of THA.
- PRISMA guidelines were followed for the systematic review.
Main Results:
- Three patients presented with advanced, unrecognized high-grade CS after THA failure, all experiencing rapid fatal outcomes.
- The literature review identified 59 articles, with 8 included, confirming the extreme rarity of primary or revision THA failure due to unrecognized CS.
Conclusions:
- Accurate diagnosis is essential before any primary or revision hip arthroplasty.
- Atypical presentations mimicking common hip pathologies warrant further investigation to rule out underlying bone sarcoma.
- Failure to recognize or adequately manage bone sarcoma can lead to severe, potentially fatal, consequences.
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.
