Total femoral replacement in patient with complicated bone hydatid cyst. Case report
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Published:
Aug 3, 2020
Keywords:
Complicated hydatid cyst, hip mega-prosthesis, infected pseudarthrosis
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Abstract
We report the case of a 31-year-old male patient presenting a femoral fracture whose complementary studies revealed an image consistent with a cystic lesion. The first biopsy study of this cyst erroneously reported a simple cyst. Osteosynthesis with intramedullary nailing was performed. The patient had a poor postoperative course associated with diaphyseal osteolytic images and loss of fracture reduction. The material was removed and intramedullary canal specimens were taken, which were positive for Pseudomonas aeruginosa and revealed remains of hydatid cysts through pathologic examination. The patient was referred to our center for the treatment of an infected pseudarthrosis secondary to a complicated hydatid bone cyst. A two-stage procedure was performed. The first stage involved the placement of an antibiotic-impregnated cement mega-spacer and the second stage involved the implantation of a total femur prosthesis as definitive treatment. The bone hydatidosis involves a challenging diagnosis, is very rare, and can cause severe dissemination. While there is no consensus or gold standard treatment for severe cases, twostagetotal femoral replacement represents an encouraging option for limb preservation, showing satisfactory short- and mediumterm outcomes.
Level of Evidence: IV
Level of Evidence: IV
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How to Cite
Isobe, F. M., Caviglia, H. A., Eljatib, A., Vargas Gonzales, J., & Lovera, J. M. (2020). Total femoral replacement in patient with complicated bone hydatid cyst. Case report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(3), 262-269. https://doi.org/10.15417/issn.1852-7434.2020.85.3.1036
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Case Presentations
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https://doi.org/10.1136/pgmj.2007.057166
2. Ministerio de Salud. Enfermedades infecciosas. Hidatidosis. Guía para el Equipo de Salud, Buenos Aires, Argentina;2012:3-26. Disponible en: http://www.msal.gob.ar/images/stories/epidemiologia/pdf/guia-medica-hidatidosis.pdf
3. Papanikolaou A. Osseous hydatid disease. Trans R Soc Trop Med Hyg 2008;102:233-8.
https://doi.org/10.1016/j.trstmh.2007.09.012
4. Kalinova K, Proichev V, Stefanova P, Tokmakova K, Poriazova E. Hydatid bone disease: a case report and review of the literature. J Orthop Surg 2005;13(3):323-5. https://doi.org/10.1177/230949900501300321
5. Bellone L, Melonari P. Enfermedades zoonóticas parasitarias. Hidatidosis. En: Consenso sobre Enfermedades
Infecciosas Regionales en la Argentina. Recomendaciones de la Sociedad Argentina de Pediatría - Comité Nacional de Infectología. Buenos Aires: Sociedad Argentina de Pediatría; 2013:8-38.
6. Igarzabal JE. Quiste hidatídico de hueso. En: Nuevo tratado de patología quirúrgica. Buenos Aires: Hachette;
1955:473-86.
7. Paz AJ. Hidatidosis ósea. Rev Asoc Argent Ortop Traumatol 1997;62(1):13-23.
https://www.aaot.org.ar/revista/1993_2002/1997/1997_1/620115.pdf
8. Agarwal S, Shah A, Khadi SK, Rooney RJ. Hydatid bone disease of the pelvis: A report of two cases and review of
the literature. Clin Orthop 1992;(280):251-5. https://doi.org/10.1097/00003086-199207000-00034
9. Agulló Bonus A, Alcalá-Santaella Oria de Rueda A. Hidatidosis muscular. A propósito de tres casos. Rev Esp Reumatol 2002;29:4-6.
https://www.semanticscholar.org/paper/Hidatidosis-muscular.-A-prop%C3%B3sito-de-tres-casos-Bonus-Rueda/
aa183951efb996352c09f5a9ae224aaaac3f95b1
10. Tomak Y, Dabak N, Gulman B, Karaismailoglu TN, Basoglu T, Incesu L. Hydatid disease of the left femur: a case report. Bull Hosp Jt Dis 2001-2002;60(2):89-93. https://pubmed.ncbi.nlm.nih.gov/12003361/
11. Inayat F, Azam S, Baig AS, Nawaz G, Ullah W. Presentation patterns, diagnostic modalities, management strategies, and clinical outcomes in patients with hydatid disease of the pelvic bone: a comparative review of 31 cases. Cureus 2019;11(3):e4178. https://doi.org/10.7759/cureus.41
12. Fica A, Soto A, Slater J, Peralta M, Humeres R, Castro M, et al. Quince años de experiencia clínica con
hidatidosis. Rev Chil Infectol 2012;29(2):183-91. https://doi.org/10.4067/S0716-10182012000200011
13. Wirbel RJ, Mues PE, Mutschler WE, Salomon-Looijen M. Hydatid disease of the pelvis and the femur. A case
report. Acta Orthop Scand 1995;66(5):440-2. https://doi.org/10.3109/17453679508995582
14. Natarajan MV, Kumar AK, Sivaseelam A, Iyakutty P, Raja M, Rajagopal TS. Using a custom mega prosthesis to
treat hydatidosis of bone: a report of 3 cases. J Orthop Surg (Hong Kong) 2002;10(2):203-5.
https://doi.org/10.1177/230949900201000216
15. Moore D, Baker KC, Les K. Hydatid disease of the femur treated with a total femoral replacement: a case report. JBJS Case Connect 2015;5(1):e7-5. https://doi.org/10.2106/JBJS.CC.M.00279