Clinical Orthopaedics and Related Research®

, Volume 471, Issue 10, pp 3319–3325

Can Certain Benign Lesions of the Proximal Femur Be Treated Without Surgery?

Clinical Research



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.


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?


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.


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.


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.


  1. 1.
    Bertoni F, Calderoni P, Bacchini P, Sudanese A, Baldini N, Present D, Campanacci M. Benign fibrous histiocytoma of bone. J Bone Joint Surg Am. 1986;68:1225–1230.PubMedGoogle Scholar
  2. 2.
    Durand S, Hamcha H, Pannier S, Padovani JP, Finidori G, Glorion C. [Fibrous dysplasia of the proximal femur in children and teenagers: surgical results in 22 cases][in French]. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:17–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Easley ME, Kneisl JS. Pathologic fractures through nonossifying fibromas: is prophylactic treatment warranted? J Pediatr Orthop. 1997;17:808–813.PubMedGoogle Scholar
  4. 4.
    George B, Abudu A, Grimer RJ, Carter SR, Tillman RM. The treatment of benign lesions of the proximal femur with non-vascularised autologous fibular strut grafts. J Bone Joint Surg Br. 2008;90:648–651.PubMedGoogle Scholar
  5. 5.
    Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect. 1986;35:357–381.PubMedGoogle Scholar
  6. 6.
    Jacofsky DJ, Haidukewych GJ. Management of pathologic fractures of the proximal femur: state of the art. J Orthop Trauma. 2004;18:459–469.PubMedCrossRefGoogle Scholar
  7. 7.
    Jaffe KA, Dunham WK. Treatment of benign lesions of the femoral head and neck. Clin Orthop Relat Res. 1990;257:134–137.PubMedGoogle Scholar
  8. 8.
    Jaffe KA, Launer EP, Scholl BM. Use of a fibular allograft strut in the treatment of benign lesions of the proximal femur. Am J Orthop (Belle Mead NJ). 2002;31:575–578.PubMedGoogle Scholar
  9. 9.
    Leong NL, Anderson ME, Gebhardt MC, Snyder BD. Computed tomography-based structural analysis for predicting fracture risk in children with benign skeletal neoplasms: comparison of specificity with that of plain radiographs. J Bone Joint Surg Am. 2010;92:1827–1833.PubMedCrossRefGoogle Scholar
  10. 10.
    Lin PP, Thenappan A, Deavers MT, Lewis VO, Yasko AW. Treatment and prognosis of chondroblastoma. Clin Orthop Relat Res. 2005;438:103–109.PubMedCrossRefGoogle Scholar
  11. 11.
    Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 2008;246:662–674.PubMedCrossRefGoogle Scholar
  12. 12.
    Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–264.PubMedGoogle Scholar
  13. 13.
    Muramatsu K, Ihara K, Taguchi T. Treatment of giant cell tumor of long bones: clinical outcome and reconstructive strategy for lower and upper limbs. Orthopedics. 2009;32:491.PubMedCrossRefGoogle Scholar
  14. 14.
    Narazaki DK, de Alverga Neto CC, Baptista AM, Caiero MT, de Camargo OP. Prognostic factors in pathologic fractures secondary to metastatic tumors. Clinics (Sao Paulo). 2006;61:313–320.Google Scholar
  15. 15.
    Osborne RL. The differential radiologic diagnosis of bone tumors. CA Cancer J Clin. 1974;24:194–211.PubMedCrossRefGoogle Scholar
  16. 16.
    Schaser KD, Bail HJ, Haas NP, Melcher I. [Treatment concepts of benign bone tumors and tumor-like bone lesions][in german]. Chirurg. 2002;73:1181–1190.PubMedCrossRefGoogle Scholar
  17. 17.
    Snyder BD, Hauser-Kara DA, Hipp JA, Zurakowski D, Hecht AC, Gebhardt MC. Predicting fracture through benign skeletal lesions with quantitative computed tomography. J Bone Joint Surg Am. 2006;88:55–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Stacy GS, Mahal RS, Peabody TD. Staging of bone tumors: a review with illustrative examples. AJR Am J Roentgenol. 2006;186:967–976.PubMedCrossRefGoogle Scholar
  19. 19.
    Wai EK, Davis AM, Griffin A, Bell RS, Wunder JS. Pathologic fractures of the proximal femur secondary to benign bone tumors. Clin Orthop Relat Res. 2001;393:279–286.PubMedCrossRefGoogle Scholar
  20. 20.
    Yanagawa T, Watanabe H, Shinozaki T, Ahmed AR, Shirakura K, Takagishi K. The natural history of disappearing bone tumours and tumour-like conditions. Clin Radiol. 2001;56:877–886.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySamsung Medical Center, Sungkyunkwan University School of MedicineGangnam-guKorea

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