case_images: PMC8035037_01
case_images: Axial (a) and coronal (b) T2 STIR weighted views on initial MRI of the pelvis showing a chondrogenic lesion of the left iliopubic ramus extending in the anterior acetabular wall.
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case_images: fig1
case_images: While the MRI showed no traumatic lesion, it revealed a tumor of her left iliopubic ramus infiltrating the anterior acetabular wall, evoking a chondrogenic tumor (Figure 1).
case_images: Computer-generated images demonstrating the resection lines (a) and the positioned cutting guides (b) based on MRI- and CT-based reconstructions of the patients' hemipelvis. (Images are courtesy of Materialise , Leuven, Belgium).
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case_images: fig2
case_images: The surgical team planned the resection margins and the cutting guides based on MRI- and CT-based reconstructions of the patients' hemipelvis were fabricated by a company specialized in medical 3D printing (Materialise , Leuven, Belgium) (Figure 2).
case_images: Intraoperative picture showing the planning of the incisions for the dual approach: Pfannenstiel and Smith-Petersen, respectively.
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case_images: fig3
case_images: A modified Smith-Petersen (Figure 3) approach was used for anterior dislocation of the hip (Figure 4) and exposure of the iliopubic eminence and the acetabulum.
case_images: Intraoperative view of the anteriorly dislocated femoral head through the Smith-Petersen approach (a) and the acetabular cavity (b) after femoral head dislocation, demonstrating the integrity of the labrum (arrow).
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case_images: fig4
case_images: A modified Smith-Petersen (Figure 3) approach was used for anterior dislocation of the hip (Figure 4) and exposure of the iliopubic eminence and the acetabulum.
case_images: Intraoperative picture showing the verification of the position of the cutting guide on the 3D-printed model of the patient's hemipelvis.
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case_images: fig5
case_images: C-section (Pfannenstiel) incision was then used to expose the iliopubic ramus. CT- and MRI-based patient-specific osteotomy guides (Figure 5) were used to perform the osteotomies through the iliopubic ramus, anterior acetabular wall, and teardrop (Figure 6).
case_images: Intraoperative pictures showing the positioned cutting guide for the osteotomy of the iliopubic ramus (a) and the anterior-superior portion of the acetabulum (b).
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case_images: fig6
case_images: C-section (Pfannenstiel) incision was then used to expose the iliopubic ramus. CT- and MRI-based patient-specific osteotomy guides (Figure 5) were used to perform the osteotomies through the iliopubic ramus, anterior acetabular wall, and teardrop (Figure 6).
case_images: Picture of the resected bone. The tumor on the iliopubic ramus infiltrating the anterosuperior portion of the acetabulum is visible.
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case_images: fig7
case_images: The specimen (Figure 7) was then dived in a serum-filled box and sterile packed (Figure 8).
case_images: Picture of the specimen after curettage and placement in a physiologic serum filled sterile container ready to be wrapped and transported to the radio-oncology department for irradiation.
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case_images: fig8
case_images: The specimen (Figure 7) was then dived in a serum-filled box and sterile packed (Figure 8).
case_images: Intraoperative picture showing the plate fixation of the recycled autograft at the level of the iliopubic ramus.
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case_images: fig9
case_images: Finally, the irradiated bone was reimplanted in its anatomical position and fixed with plates and screws (Figure 9).
case_images: Plain film at 4 years of follow-up showing healed osteotomy sites without signs of femoral head avascular necrosis or osteoarthritis. Note the presence of heterotopic ossification.
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case_images: fig10
case_images: Plain films revealed healed osteotomy sites and no signs of femoral head avascular necrosis or osteoarthritis (Figure 10).
case_images: PMC8035037_02
case_images: AP pelvic plain film showing a lytic lesion of the left iliopubic ramus.
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case_images: fig11
case_images: A plain film of the left hip showed a lytic lesion of the iliopubic ramus (Figure 11).
case_images: Axial (a) and coronal (b) T1 TSE sequence views on initial MRI of the pelvis showing a tumor of the left iliopubic ramus.
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case_images: PMC8035037_02_CRIOR2021-5512143.012.jpg
case_images: fig12
case_images: MRI of the pelvis revealed a chondrogenic lesion of the left iliopubic ramus extending in the anterior acetabular wall (Figure 12).
case_images: Plain film at 30 months of follow-up showing a mild thinning of the joint line.
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case_images: fig13
case_images: Radiological workup at six months of follow-up revealed arthritic changes of the hip in its anterior portion (Figures 13 and 14(a)).
case_images: Axial view of a CT scan at 6 months (a) and at 30 months of follow-up (b) showing the healing of the osteotomy and the progression of osteoarthritis in the articular portion of the recycled autograft.
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case_images: fig14
case_images: Radiological workup at six months of follow-up revealed arthritic changes of the hip in its anterior portion (Figures 13 and 14(a)). At 30 months of follow-up, plain films showed complete healing at the osteotomy sites and mild progression of the osteoarthritic changes (Figure 14(b)).