Akademik Veri Yönetim Sistemi
15th Asia-Pacific Musculoskeletal Tumor Society (APMSTS) Meeting, Denpasar, Endonezya, 8 - 11 Ekim 2025, ss.20, (Özet Bildiri)
**Background:**
Chondroid tumors in the femoral head present a significant diagnostic and therapeutic challenge due to their ambiguous histological characteristics and complex anatomical location. The femoral head’s deep intra-articular positioning and tenuous vascular supply limit the safety of both diagnostic biopsies and conventional oncological interventions. Although distinguishing between enchondroma and low-grade chondrosarcoma remains difficult, there is no consensus on a standard treatment strategy, particularly in anatomically constrained areas like the femoral head. This study aimed to evaluate the feasibility and outcomes of a hip-preserving surgical approach that combines intra-articular access and extended intralesional curettage without a preoperative biopsy for femoral head cartilage tumors.
**Methods:**
A retrospective review was conducted on nine adult patients (eight females, one male; mean age 43 years) treated between 2004 and 2020 at a musculoskeletal oncology referral center. All patients had solitary chondroid lesions in the femoral head, with no preoperative biopsy performed. Surgery was executed using either the Ludloff or Smith-Petersen approach without dislocating the hip joint. The lesions were excised en bloc under direct visual and fluoroscopy guidance. Extended curettage, local adjuvant treatment with phenol and electrocauterization, and reconstruction with polymethylmethacrylate cement were performed. Patients were followed for a mean duration of 65 months (range 38–111 months), with assessments of radiological healing, functional recovery, complications, and oncological control.
**Results:**
Histopathological diagnoses included five enchondromas and four low-grade chondrosarcomas (including one with focal grade 2 changes). Lesions were predominantly located inferomedially in the femoral head. No local recurrence or metastasis was observed; all patients were classified as “no evidence of disease” (NED) per ISOLS criteria at final follow-up. Functional outcomes were excellent, with mean MSTS and Harris Hip Scores of 93.4% and 95, respectively. One patient sustained a nondisplaced femoral neck fracture at seven weeks postoperatively, successfully treated with percutaneous screw fixation. There were no cases of avascular necrosis, joint degeneration, or significant soft tissue complications.
**Discussion:**
Our findings suggest that hip-preserving surgery for femoral head cartilage tumors can be performed safely without a preoperative biopsy in selected patients, provided that radiologic features are typical. Avoiding biopsy in this region minimizes the risk of contamination and cartilage compromise, which might otherwise necessitate arthroplasty. Compared to previous case reports involving arthroscopy or hip dislocation, our approach uniquely preserves both the cartilage and blood supply of the femoral head. While limited by its retrospective design and small cohort size, the study demonstrates a novel, reproducible technique with promising mid-term outcomes.
**Conclusion:**
Hip-preserving intralesional surgery without prior biopsy is a viable and oncologically safe option for managing chondroid tumors in the femoral head in young and middle-aged adults. This technique offers excellent functional and radiological outcomes with minimal complications. Further prospective studies with larger patient populations and long-term follow-up are warranted to validate these findings and refine patient selection criteria.