Chondroblastoma

 

Chondroblastoma hipFemoral head chondroblastoma

 

Definition

 

Rare cartilage tumour in epiphysis / apophysis

Benign but locally aggressive

 

Epidemiology

 

1% of bone tumours

Most patients < 20 years

 

Location

 

Epiphysis of long bones

 

Ebeid et al J Paediatr Orthop 2019

- 91 cases

- 26% proximal tibia

- 22% distal femur

- 19% proximal humerus

- 17% proximal femur

 

Apophysis of talus / calcaneus

 

Patella / scapula / posterior elements vertebrae

 

Natural history

 

Usually benign

 

Rare reports of locally aggressive lesions / metastasis

 

Clinical

 

Present with pain

 

X-ray

 

Well defined eccentrically located epiphyseal lesion

- thin sclerotic reactive rim

- may have calcification

 

ChondroblastomaChondroblastoma hip

 

MRI

 

Rarely diagnostic

- high signal intensity on T2

 

Chondroblastoma xrayChondroblastoma MRI

 

ChondroblastomaChondroblastoma MRIChondroblastoma MRI

 

CT

 

Evaluate articular surface integrity / compromise

Identify chondroid matrix

 

CT chondroblastoma 1CT chondroblastoma 2

 

Differential diagnosis

  

Epiphyseal lesion in adults

- chondroblastoma

- GCT

- ABC / UBC

- clear cell chondrosarcoma

- infection / Brodie abscess

 

Histology

 

Chondroblastoma Histology

 

Sheets of chondroblasts

- chondroid matrix

- dystrophic calcification

 

Can be secondary ABC

 

Management

 

Options

 

1.  Intra-lesional excision and bone graft

2.  Radiofrequency ablation

3.  Wide excision

 

Intra - Lesional Curettage + Bone Graft

 

Chondroblastoma Intralesional Currettage and PMMAChondroblastoma bone graft

Cementing                                                                   Bone graft and cement

 

Technique

- cortical window

- care with growth plate

- meticulous debridement with burr

- fill defect with bone graft / cement

- stabilize if necessary

 

Chondroblastoma CT hipChondrolbastoma hip curretteChondroblastoma hip ORIF

 

Results curettage + bone graft

 

Xu et al JBJS Am 2015

- 199 patients with chondroblastoma

- curettage and bone graft

- recurrence rate 5%

 

Ebeid et al J Paediatr Orthop 2019

- 91 cases treated with curettage / bone graft / cement

- recurrence rate 3% (3/91)

 

Results curettage + bone substitute

 

Outani et al World J Surg Oncol 2020

- 40 cases chondroblastoma

- curettage and bone substitute

- recurrent rate 10% (8/40)

 

Femoral head osteoblastoma

 

Xu et al CORR 2014

- 14 cases

- open dislocation and modified trapdoor approach

- no local recurrence

- one case AVN requiring joint replacement

 

Femoral head chondroblastomaCB hipFemoral CB

 

Radiofrequency ablation

 

Indication

- small

- joint surface not at risk

 

Results

 

Xie et al Eur Radiol 2015

- 25 cases treated with RF ablation

- 88% of patients became asymptomatic

 

Kulkarni et al J Vasc Interv Radiol 2021

- 27 cases treated with RF ablation

- 93% complete pain relief at 6 weeks

- 2 cases developed osteonecrosis and joint space collapse

 

Wide Resection / Allograft / Prosthesis

 

Indication

- articular surface compromised

- joint collapse

- recurrence after previous surgery