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The Journal of Bone and Joint Surgery 82:1536 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Occult Sarcoma of the Femoral Head in Patients Undergoing Total Hip Arthroplasty

A Report of Two Cases*

Steven D. Billings, M.D.{dagger}, L. Daniel Wurtz, M.D.{dagger}, Eduardo Tejada, M.D.{ddagger} and John D. Henjey, M.D.{dagger}

Investigation performed at the Departments of Pathology and Laboratory Medicine and Orthopaedic Surgery, Indiana University School of Medicine, and the Department of Pathology and Laboratory Medicine, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Departments of Pathology and Laboratory Medicine (S. D. B. and J. D. H.) and Orthopaedic Surgery (L. D. W.), Indiana University Hospital, 550 North University Boulevard, Indianapolis, Indiana 46202.
{ddagger}Department of Pathology and Laboratory Medicine, Richard L. Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, Indiana 46202.


   Introduction
 
Total hip arthroplasty is a common treatment for patients with arthritic conditions of the hip joint. Removal of the diseased femoral head is an essential part of this operative procedure. A subsequent pathological examination of the femoral head generally confirms the clinical diagnosis. Recently, however, primary sarcoma of the femoral head was discovered in the specimens from two patients undergoing total hip arthroplasty for presumed benign disease. Although neither patient had clinical evidence of a malignant tumor, both had risk factors for the development of sarcoma in their medical history.


   Case Reports
 
Case 1. A forty-six-year-old woman presented with a two-week history of pain in the left hip and an inability to walk. She had a history of cervical cancer; treatment had included pelvic exenteration with adjuvant radiation and chemotherapy seventeen years prior to the onset of the hip symptoms. Plain radiographs and magnetic resonance imaging showed changes consistent with avascular necrosis . . . [Full Text of this Article]


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