Artificial Hemipelvic Displacement Treatment for Bone Hydatid Disease
Hydatid disease, also known as echinococcosis, is a parasitic infection caused by the tapeworm Echinococcus. This condition is a rare anthropozoonosis, meaning it is a disease that can be transmitted from animals to humans. While hydatid disease commonly affects organs such as the liver and lungs, bone involvement is exceedingly rare, occurring in approximately 3% of cases. When it does affect bone, the ribs, pelvis, and skull are the most frequently involved sites. This article presents a detailed case of bone hydatid disease in a 35-year-old female patient from Qinghai province, China, who underwent artificial hemipelvic displacement as a treatment for severe pelvic and femoral head collapse caused by hydatid cysts.
Case Presentation
The patient, a 35-year-old female, was admitted to Peking University First Hospital with a 14-year history of progressive paracoxalgia (pain around the hip joint) and lower limb weakness in her left leg. Her symptoms began after a fall from a standing height, which resulted in a pathologic fracture of the femoral neck. Despite conservative treatment, the fracture malunited, leading to persistent pain and disability. Four years prior to her admission, the patient noticed that several masses around her left hip joint had grown in size, accompanied by unrelieved pain despite analgesic therapy. A biopsy performed two years before her admission confirmed the diagnosis of hydatid disease.
Imaging studies, including plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI), revealed severe collapse of the pelvis and femoral head on the left side due to the presence of hydatid cysts. The MRI also showed that the muscles surrounding the hip joint were invaded by numerous hydatid cysts, further complicating the clinical picture. The extent of the disease was so severe that it necessitated a radical surgical approach to restore function and alleviate pain.
Diagnostic Imaging
Diagnostic imaging plays a crucial role in the evaluation of hydatid disease, particularly when it involves bone. In this case, plain radiographs and CT scans revealed the extent of bone destruction caused by the hydatid cysts. The pelvis and femoral head were severely collapsed, indicating advanced disease. MRI was particularly useful in assessing the involvement of soft tissues, showing that the muscles around the hip joint were extensively invaded by hydatid cysts. The imaging findings were critical in planning the surgical approach and determining the extent of tissue resection required.
While imaging is essential for diagnosing hydatid disease, it can be challenging to differentiate bone hydatid cysts from other bone lesions based solely on radiological findings. The diagnosis is often confirmed through biopsy and serological tests, such as the Casoni test and indirect hemagglutination test, which are specific for hydatid disease.
Treatment Strategy
The treatment of bone hydatid disease typically involves a combination of surgical excision and long-term chemotherapy. In this case, the patient’s severe pelvic and femoral head collapse necessitated a more aggressive approach. Artificial hemipelvic displacement was chosen as the treatment of choice to restore hip joint function and provide structural support.
The treatment was carried out in two stages. In the first stage, the hydatid cysts in the muscles surrounding the hip joint were carefully incised and debrided. This step was crucial to reduce the parasitic load and minimize the risk of recurrence. Three months after the initial debridement, the second stage of the surgery was performed. During this stage, the collapsed pelvis and proximal femur were removed, and the hip joint was displaced with an artificial hemipelvis and hip joint prosthesis.
Surgical Procedure
The surgical procedure involved the complete removal of the affected bones and the implantation of an artificial hemipelvis and hip joint. The procedure was technically challenging due to the extensive destruction of the pelvic and femoral structures. The surgeons had to carefully excise all affected tissues while preserving as much healthy tissue as possible. The artificial hemipelvis was designed to provide structural support and restore hip joint function, allowing the patient to regain mobility and weight-bearing capacity.
Postoperatively, the patient was placed on a regimen of oral chemotherapy with albendazole, a medication commonly used to treat hydatid disease. Albendazole was administered daily as part of a combination strategy to prevent recurrence and ensure the complete eradication of the parasite. The patient was closely monitored for any signs of recurrence or complications.
Follow-Up and Outcomes
At the six-month follow-up, the patient had regained full weight-bearing capacity in her left leg, indicating a successful outcome of the surgical procedure. Over the course of two years, the patient reported no discomfort or recurrence of symptoms, further confirming the effectiveness of the treatment. The artificial hemipelvis and hip joint prosthesis provided stable support, allowing the patient to resume normal activities without pain or disability.
Discussion
Bone hydatid disease is a rare but severe manifestation of Echinococcus infection. The disease can lead to significant bone destruction and functional impairment, particularly when it involves weight-bearing structures such as the pelvis and femur. In this case, the patient’s long-standing disease and severe pelvic collapse necessitated a radical surgical approach. Artificial hemipelvic displacement was chosen as the treatment of choice to restore hip joint function and provide structural support.
The use of artificial hemipelvic displacement in the treatment of bone hydatid disease is a novel approach, and this case represents the first reported instance of its use in such a context. The successful outcome highlights the potential of this surgical technique in managing severe cases of bone hydatid disease. However, it is important to note that this approach is technically demanding and requires careful patient selection and surgical planning.
The combination of surgical excision and long-term chemotherapy with albendazole is the cornerstone of treatment for hydatid disease. Albendazole is effective in reducing the parasitic load and preventing recurrence, but it must be administered for an extended period, often for at least two years or even lifelong in some cases. In this patient, the combination of surgical intervention and chemotherapy resulted in a favorable outcome, with no recurrence observed during the two-year follow-up period.
Conclusion
Bone hydatid disease is a rare but devastating condition that can lead to significant bone destruction and functional impairment. The case presented here illustrates the challenges associated with diagnosing and treating this condition, particularly when it involves weight-bearing structures such as the pelvis and femur. Artificial hemipelvic displacement, combined with long-term chemotherapy, represents a promising treatment option for severe cases of bone hydatid disease. The successful outcome in this patient underscores the importance of a multidisciplinary approach to managing this complex condition, involving careful surgical planning, aggressive debridement, and long-term medical therapy.
doi.org/10.1097/CM9.0000000000000281
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