Can Certain Benign Lesions of the Proximal Femur Be Treated Without Surgery?
BACKGROUND: Benign lesions in the proximal femur can cause pathologic fractures. To avoid fracture, benign tumors and tumor-like lesions in this region often are treated surgically, yet there have been few reports regarding the decision-making processes or protocols for nonsurgical treatment of these lesions. QUESTIONS/PURPOSES: In this study, we asked (1) whether some benign lesions of the proximal femur can be managed safely using a conservative protocol, and (2) if observed according to such a protocol, what are the outcomes of such lesions at this anatomic site? METHODS: Fifty-four consecutive patients who had been followed for at least 12 months were enrolled in this study. The mean age of the patients at first visit was 38 years (range, 13-70 years), and the minimum followup was 12 months (mean, 25 months; range, 12-59 months). After ruling out malignancy, lesions were categorized as aggressive benign tumors or nonaggressive benign lesions using a standardized approach. We used conservative treatment for most patients with nonaggressive, benign lesions. Surgery was performed only for patients with nonaggressive lesions who met our fracture risk criteria: pain on initiating hip movement, progressively worsening pain, cortical thinning, and the absence of a sclerotic margin. RESULTS: Of the 47 patients with a nonaggressive, benign lesion without fracture at presentation, 83% were treated conservatively and only 10% of these patients had progression of the lesion. No new pathologic fractures developed during followup. In 88% of patients who presented with pain that was managed conservatively, pain improved either partially or completely at final followup. CONCLUSIONS: Most nonaggressive, benign lesions in the proximal femur can be treated conservatively, and our protocol appears to be a useful outpatient guideline. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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