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The Journal of Bone and Joint Surgery (American) 85:1790-1794 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Extraspinal Bone Hydatidosis

Antonio Herrera, MD and Angel A. Martínez, MD

Investigation performed at the Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, Zaragoza, Spain

Antonio Herrera, MD
Angel A. Martínez, MD
Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, Avd. Isabel la Catolica, n°1-3, Zaragoza 50009, Spain. E-mail address for A. Herrera: aherrerar{at}wanadoo.es

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Bone hydatidosis caused by the tapeworm larva, Echinococcus granulosis, is rare. Extraspinal locations are even rarer. We report our experience with the treatment of twenty-six patients with extraspinal osseous hydatidosis.

Methods: Between 1972 and 1998, we treated twenty-six patients with extraspinal hydatidosis. There were sixteen men and ten women, with a mean age of 51.5 years. The mean duration of follow-up was 12.8 years. The infected area was the ilium in four patients, the ilium and sacral ala in two, the ilium and hip in eight, the femoral head and the acetabular roof in five, the femoral shaft in one, the distal part of the femur in one, the femoral head in one, the scapula in two, and the ribs in two. All patients were treated with curettage or wide resection. Chemotherapy was used in all but five patients.

Results: Nineteen patients (73%) were free of disease at the time of the last follow-up. Repeated curettage or wide resection was necessary in nine of these patients; it was required in three of the nine because of surgical wound infection and in six because of recurrence. Of the seven patients who were not free of disease at the time of the last follow-up, six had persistent chronic productive sinuses and one had a chronic wound infection. The cases involving both the ilium and the hip were the most difficult to treat. Radical surgery is difficult in this location, and numerous surgical procedures were always required.

Conclusions: The results of treatment of osseous hydatidosis are satisfactory only in locations where complete and wide excision is possible. In the pelvis and hip, where radical surgery is almost impossible, the results are disappointing.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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