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Goodwin TM, White CC, Wetzler A, Cincere BA. Paralabral Cyst of the Hip Causing Deep Vein Thrombosis Treated with Arthroscopic Decompression and Labral Repair. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00010. [PMID: 38265245 PMCID: PMC10807876 DOI: 10.5435/jaaosglobal-d-23-00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024]
Abstract
In the setting of femoroacetabular impingement of the hip joint, paralabral cysts are well-documented sequelae. These cysts are typically associated with labral tears caused by CAM and/or pincer-type bony lesions. Synovial fluid extravasation through a tear in the labrum, similar to a popliteus cyst, leads to formation of a capsular-based cyst that is usually self-limiting. Few documented cases of these cysts causing compression of nearby neurovascular structures exist. There are several studies documenting arthroscopic decompression of these cysts, but none reporting compression of the femoral vein by a paralabral cyst resulting in deep vein thrombosis. We present the case of a large anterior paralabral cyst causing compression of the right femoral vein in a patient presenting with deep vein thrombosis and hip pain. Treatment consisted of arthroscopic decompression, followed by definitive aspiration by interventional radiology after labral repair and bipolar hip osteoplasty. The purpose of this case report was to document this rare presentation and offer learning points from our experience.
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Affiliation(s)
- Tyler M. Goodwin
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Charles Cody White
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Austin Wetzler
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
| | - Brandon A. Cincere
- From the University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, TN (Dr. Goodwin, Dr. White, and Dr. Cincere), and the Lewis Katz School of Medicine at Temple University (Mr. Wetzler), Philadelphia, PA
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Lovaglio AC, Mansilla B, Cejas C, Spinner RJ, Socolovsky M. Femoral intraneural ganglion cyst: the first confirmed case report. Br J Neurosurg 2023; 37:1251-1253. [PMID: 33151109 DOI: 10.1080/02688697.2020.1842853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ganglion cysts affecting nerve are rare causes of neuropathy. The formation of intraneural ganglion cysts, once controversial, has recently been clarified. We describe the first modern description of a femoral intraneural ganglion cyst at the hip region. METHODS A patient presented with a 1 year history of radiating pain, quadriceps weakness and anteromedial leg numbness was found to have a femoral intraneural cyst with a hip joint connection on MRI. RESULTS Surgical disconnection of the articular branch led to improvement of the neuropathy and resolution of the cyst on postoperative MRI. CONCLUSIONS The unifying articular (synovial) theory describes the joint origin of intraneural cysts, even when they occur in unusual locations, and their propagation into the parent nerve. Knowledge of this theory can improve outcomes; surgery needs to address the joint origin or capsulolabral defect lest recurrence ensue.
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Affiliation(s)
- Ana C Lovaglio
- Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Beatriz Mansilla
- Department of Neurosurgery, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Claudia Cejas
- Department of Diagnostic Imaging, Raúl Carrea Foundation for Neurological Research, FLENI, Buenos Aires, Argentina
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mariano Socolovsky
- Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
- Department of Neurosurgery, Raúl Carrea Foundation for Neurological Research, FLENI, Buenos Aires, Argentina
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Minimum 5-year follow-up of arthroscopic treatment of symptomatic iliopectineal cyst. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1369-1374. [PMID: 33528642 DOI: 10.1007/s00590-021-02877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to primarily assess the clinical and functional outcomes of arthroscopic treatment of the symptomatic iliopectineal cyst at a minimum 5-year follow-up. Our secondary objective was to document the technical nuances of our arthroscopic technique. METHODS A retrospective review of chart data was performed for 30 patients who underwent arthroscopic treatment of a symptomatic iliopectineal cyst in the period between 1999 and 2015. The mean age of our patients was 57 (33-78) years. All patients completed a minimum follow-up period of 5 years. Our clinical outcomes were assessed by 100 mm VAS for pain, recurrence rate and complications. Functional outcome was evaluated by the modified Harris hip score (mHHS). Patients were asked their level of satisfaction with surgery on a scale of 0-10. RESULTS In all patients, the valve mechanism of the iliopectineal cyst could be released arthroscopically and the cyst could be completely evacuated. The preoperative symptoms disappeared within 3-6 weeks after the arthroscopic intervention. Patients showed significant improvement in VAS and mHHS 6 months postoperatively and at final follow-up. The average patient satisfaction was 9.2 at 6 months postoperative and 7.9 at final follow-up. None of our patients experienced any complications. At the final follow-up, there was neither clinical nor radiological evidence of cyst recurrence. CONCLUSIONS Arthroscopic treatment of the iliopectineal cyst is a feasible and safe alternative to open surgery resulting in significant improvement of clinical and functional outcomes.
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Chang KV, Wu WT, Lin WT, Lin CP. A Female Patient with Right Anterior Hip Pain: A Paralabral Cyst of the Hip. J Med Ultrasound 2019; 28:273-274. [PMID: 33659174 PMCID: PMC7869726 DOI: 10.4103/jmu.jmu_88_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Wen-Ting Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Pachore JA, Shah VI, Upadhyay S, Shah K, Seth A, Kshatriya A. Compressive Femoral Mononeuropathy Secondary to Acetabular Labral Tear Associated With Paralabral Ganglion Cyst of an Osteoarthritic Hip: A Case Report. JBJS Case Connect 2019; 9:e0344. [PMID: 31343999 DOI: 10.2106/jbjs.cc.18.00344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CASE A 61-year-old man presented with a 5-year history of left hip pain and a 6-month history of left groin swelling associated with hypoesthesia and proximal muscle weakness. Radiograph of the left hip showed degenerative joint disease. Magnetic resonance imaging revealed a large, anteriorly displaced paralabral cyst of the left hip joint. Neurophysiologic studies were corroborative of left femoral mononeuropathy. Complete excision of the cyst along with total hip replacement were performed. At 4-year follow-up, there was complete remission with resolution of symptoms. CONCLUSIONS Our experience emphasizes the importance of identifying and addressing the underlying primary pathologic disease for a satisfactory functional outcome.
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Affiliation(s)
| | | | - Sachin Upadhyay
- Department of Orthopaedics, NSCB Medical College, Jabalpur, India.,Department of Trauma, Joints and Minimal Invasive Surgery, Shalby Hospitals, Jabalpur, India
| | - Kalpesh Shah
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India
| | - Ashish Seth
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India
| | - Amish Kshatriya
- Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India
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Lee YK, Kim JM, Yoon BI, Kim JY, Lee GY, Kim S, Ha YC. Location and Correlation of Acetabular Labral Tears and Paralabral Cysts Using Magnetic Resonance Imaging or Magnetic Resonance Arthrography in Patients With Femoroacetabular Impingement. Arthroscopy 2019; 35:809-815. [PMID: 30733031 DOI: 10.1016/j.arthro.2018.10.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 09/27/2018] [Accepted: 10/23/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the prevalence and location of paralabral cysts and the correlation between the type of femoroacetabular impingement (FAI) and acetabular labral tears, as well as the location of the paralabral cysts. METHODS Patients who received a diagnosis of FAI syndrome using plain radiography, magnetic resonance imaging or magnetic resonance arthrography, or computed tomographic arthrography from 2010 to 2015 were included in this study. The exclusion criteria were patients with arthritis (Tönnis grade 2 or greater) or dysplasia. We identified paralabral cysts and their location, size, configuration. Correlations between the type of FAI and labral tears and paralabral cysts were analyzed using the χ-square test. RESULTS Among 506 patients with FAI, paralabral cysts were found in 51 patients (55 hips) and were located anterosuperiorly in 40% of cases, posterosuperiorly in 36%, anteroinferiorly in 17%, and posteroinferiorly in 8%. We identified multilocular cysts in 60% of hips and unilocular cysts in 40%. Labral tears were radiographically found in 44 of 55 hips with paralabral cysts (80%); they were located anterosuperiorly in 59% and posterosuperiorly in 41%. Although paralabral cysts were found in the anteroinferior and posteroinferior areas, acetabular labral tears were not identified in the anteroinferior and posteroinferior areas. Classification of the type of FAI showed cam type in 14 of 55 hips (25.5%), pincer type in 16 (29%), mixed type in 7 (13%), labral tears in 15 (27%), and normal findings in 3 (5.5%). No correlation was found between the type of FAI and labral tears (P = .739) or the location of paralabral cysts (P = .228). CONCLUSIONS Paralabral cysts in patients with FAI most commonly are found in the anterosuperior area and are of the multilocular type. Although paralabral cysts in the anterosuperior and posterosuperior portions are related to labral tears, those in the anteroinferior and posteroinferior portions are not. LEVEL OF EVIDENCE Level IV, diagnostic case series.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung-Il Yoon
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Guen Young Lee
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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Ganokroj P, Lertwanich P. Arthroscopic Treatment of a Groin Mass Caused by a Paralabral Cyst. Orthopedics 2018; 41:e724-e726. [PMID: 29913032 DOI: 10.3928/01477447-20180613-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 02/05/2018] [Indexed: 02/03/2023]
Abstract
A groin mass is an unusual presentation of hip-related problems. Paralabral cysts are common radiographic findings that are often associated with intraarticular pathology. The authors describe a 57-year-old woman who presented with a left groin mass for 6 months. Magnetic resonance imaging showed an acetabular paralabral cyst at the anterior aspect of the hip joint. Arthroscopic paralabral cyst decompression was performed. An associated degenerative anterosuperior labrum and partial tear of the ligamentum teres were also identified and treated with arthroscopic debridement. Postoperative imaging showed complete resolution of the cyst. There was no recurrence at the 2-year follow-up. [Orthopedics. 2018; 41(5):e724-e726.].
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Byrne C, Whitty S, Stanley E, Alkhayat A, Eustace SJ, Kavanagh EC. Acetabular paralabral cyst causing compression of the sciatic nerve. Radiol Case Rep 2018; 12:821-823. [PMID: 29484079 PMCID: PMC5823297 DOI: 10.1016/j.radcr.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022] Open
Abstract
Acetabular paralabral cysts are common. They vary in their clinical presentation and may be asymptomatic or cause pain and restriction at the hip joint. In rare instances they may cause symptoms by compressing local neurovascular structures. We report a case of symptomatic compression of the sciatic nerve by a posteriorly displaced acetabular paralabral cyst.
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Affiliation(s)
- Caoimhe Byrne
- Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas West, Dublin 11, Ireland
| | - Sharon Whitty
- UCD school of Medicine and Medical Science, Health Science Centre, Belfield, Dublin 4
| | - Emma Stanley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - Abdullah Alkhayat
- Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas West, Dublin 11, Ireland
| | - Stephen J Eustace
- Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas West, Dublin 11, Ireland.,Mater Misericordiae University Hospital, Eccles Street, Dublin 7.,Mater Private Hospital, Eccles Street, Dublin 7
| | - Eoin C Kavanagh
- Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas West, Dublin 11, Ireland.,Mater Misericordiae University Hospital, Eccles Street, Dublin 7.,Mater Private Hospital, Eccles Street, Dublin 7
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Shin KY, Park SJ, Lee WS. Paralabral Cyst of the Hip Compressing Common Femoral Vein Treated with Sono-guided Cyst Aspiration Followed by Arthroscopic Labral Debridement: A Case Report. Hip Pelvis 2017; 29:194-198. [PMID: 28955686 PMCID: PMC5612980 DOI: 10.5371/hp.2017.29.3.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/17/2017] [Accepted: 08/01/2017] [Indexed: 12/02/2022] Open
Abstract
Paralabral cyst around hip is reported to be a cause of compression of the major neurovascular structures. Although, arthroscopic cyst and labral debridement is generally accepted as the effective treatment, there is limited literature available regarding treatment options for paralabral cysts in the hip. We present a case of paralabral cyst compressing left common femoral vein in the hip that was treated with sono-guided cyst aspiration followed by arthroscopic labral debridement.
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Affiliation(s)
- Keun-Young Shin
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seoungnam, Korea
| | - Sang-Jun Park
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seoungnam, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Seoul, Korea
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Bruyere A, Hidalgo Diaz JJ, Vernet P, Salazar Botero S, Facca S, Liverneaux PA. Technical feasibility of robot-assisted minimally-invasive neurolysis of the lateral cutaneous nerve of thigh: About a case. ANN CHIR PLAST ESTH 2016; 61:872-876. [PMID: 27209566 DOI: 10.1016/j.anplas.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/10/2016] [Indexed: 11/28/2022]
Abstract
To limit the risk of iatrogenic neuroma and recurrence after surgical treatment of meralgia paresthetica, some authors have recently developed a technique of endoscopic neurolysis of the lateral cutaneous nerve of thigh (LCNT) below the level of the inguinal ligament. We report the case of a robot-assisted endoscopic technique underneath the inguinal ligament. A 62-year-old patient suffering of idiopathic meralgia paresthetica for the past 18 months received a Da Vinci robot-assisted minimally-invasive 10cm long neurolysis, of which 1/3 was situated above the level of the inguinal ligament and 2/3 below it. The patient was discharged the following day without complications. At 6-months follow-up the pain was rated 0/10 compared to 5/10 pre-operatively. Robot-assisted endoscopic neurolysis of the LCNT retains the advantages of conventional endoscopy and enables to approach the nerve in the most frequently compressed zone underneath the inguinal ligament. The three-dimensional view offered by robotic surgery facilitates the dissection. The superiority of this technique remains to be demonstrated by comparing it to conventional techniques.
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Affiliation(s)
- A Bruyere
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - J J Hidalgo Diaz
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - P Vernet
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - S Salazar Botero
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - S Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - P-A Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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