Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia.

AIM OF THE STUDY: To compare the outcomes after computer-assisted peri-acetabular osteotomy (PAO) and conventional PAO performed for hip dysplasia (DDH). METHODS: Ninety-one patients (98 hips) were enrolled in this study. In each case, DDH was treated with either conventional PAO, in which the angle and direction of the osteotomy was determined by intra-operative X-ray examination, or with computer-assisted PAO, which used the 3D navigation system. Forty hips underwent conventional PAO and 58 hips underwent computer-assisted PAO. RESULTS: Japanese Orthopaedic Association hip scores improved significantly from 70.0 points pre-operatively to 90.7 points post-operatively in patients with conventional PAO, and from 74.5 points pre-operatively to 94.2 points post-operatively in patients with computer-assisted PAO. In all patients with computer-assisted PAO, the post-operative AHI and VCA angle were within the radiographic target zone. Some patients with conventional PAO had post-operative AHI and VCA angle outside of the target zone. We performed total hip arthroplasty (THA) on five of the 98 PAO hips (5.1%) after an average follow-up period of 5.4 years. None of 58 hips (0%) with computer-assisted PAO was revised. DISCUSSION: Computer-assisted PAO enabled intra-operative confirmation of osteotomy sites, and the position of the osteotomized bone fragment could be confirmed in real time. Adequate anterior and lateral coverage of the femoral head in patients with computer-assisted PAO resulted in no need for early conversion to THA, in contrast to conventional PAO. CONCLUSION: Computer-assisted PAO not only improved accuracy and safety but also achieved sufficient anterior and lateral displacement to prevent the progression of DDH.

Intraosseous synovial sarcoma of the distal ulna: a case report and review of the literature.

BACKGROUND: Synovial sarcoma is a relatively rare type of soft tissue sarcoma. The commonly observed symptom is a deep-seated palpable mass accompanied by pain or tenderness. Thus, it is considered a soft tissue sarcoma and rarely occurs primarily in bone. However, only few studies have been reported on intraosseous synovial sarcoma, and reports on cases with cytogenetic or molecular confirmation are even rarer. We report a case of intraosseous synovial sarcoma of the distal ulna that has been confirmed using histopathological examination and molecular analysis. CASE PRESENTATION: A 77-year-old female was referred to our hospital with a 1-month history of right wrist pain after housework. Clinical and imaging findings suggested a benign bone tumor that was enhanced by Gd-DTPA. It was thought that the tumor was possibly an enchondroma. Initially, we planned to evaluate the benignancy of the tumor with intraoperative frozen section, followed by curettage and bone graft at one stage However, when considering carefully, characteristics of the tumor did not perfectly match those of any diagnostic categories including enchondroma. Therefore, an incisional biopsy was performed and revealed that the tumor was synovial sarcoma. Following an elaborate plan, the patient underwent a wide resection of the tumor at the distal part of the right ulna. Reverse transcription-polymerase chain reaction (RT-PCR) from the resected specimen and sequencing of RT-PCR products demonstrated a chimeric SYT-SSX1 transcript, confirming the diagnosis of synovial sarcoma. CONCLUSIONS: Synovial sarcoma is seldom considered in differential diagnosis of bone tumors because it is difficult to line up such an unusual diagnosis as a differential diagnosis. When the lesion does not perfectly fit into any diagnostic category, when the initial image diagnosis appears unconvincing, biopsy and pathology are indicated, recalling Jaffe's triangle. According to these diagnostic processes, the patient successfully completed the treatment for this rare intraosseous synovial sarcoma, following a careful plan based on the preoperative diagnosis.

Radiolucency around highly porous sockets and hydroxyapatite-coated porous sockets in total hip arthroplasty for hip dysplasia.

Studies over the past decade have reported that the use of highly porous sockets in total hip arthroplasty (THA) results in osseointegration and long-term implant stability. However, some reports have raised concerns regarding radiographic evidence of poor osseointegration with features of fibrous tissue ingrowth. The purpose of this study was to compare clinical and radiographic assessments of highly porous sockets with those of hydroxyapatite (HA)-coated porous sockets in THA for hip dysplasia (DDH) at least 1 year after surgery. A total of 127 patients (136 hips) were recruited for the study. Of these, 94 patients (101 hips) received highly porous sockets with clustered screws, while 33 patients (35 hips) received HA-coated porous sockets with clustered screws. There was no difference in clinical outcomes between the two types of sockets. All HA-coated porous sockets were radiographically stable, without radiolucent lines. Fifteen hips had radiolucent lines in two or three DeLee and Charnley zones, accompanied by sclerotic lines along the circumferences of the highly porous sockets. A significant difference in the height of the preoperative osteophyte of the anterior acetabular wall was observed between 86 hips with one or no radiolucent lines and 15 hips with two or three radiolucent lines. In cases of DDH with atrophic bone remodeling pattern, highly porous sockets with multiple screws may be used, while HA-coated porous sockets with clustered screws result in better sealing of the bone-component interface.

Acetabular reconstruction with the Kerboull-type plate at mid-term follow-up: survivorship analysis and prognostic factors for loosening.

INTRODUCTION: Successful reconstruction during total hip arthroplasty for acetabular bone defects remains challenging. The purpose of our study was to evaluate clinical and radiographic results and performed a survivorship analysis for patients with acetabular bone loss undergoing total hip arthroplasty (THA) or revision THA using Kerboull-type acetabular reinforcement device(KT plate). Additionally, some independent prognostic factors for radiographic failure were identified. METHODS: A retrospective cohort study was conducted. Thirty patients (36 hips) were available for follow-up examination between 1997 and 2012, with a mean follow-up period of 10 years. We evaluated clinical and radiographic results. The mean patient age at the time of the operation was 66 years. RESULTS: Failure occurred in 6 cases, and further revisions were required for 2 hips. With failure for any reason as an endpoint, the cumulative survival at 10 years was 85%. Survival analysis at 10 years with failure as the endpoint revealed that the inclination angle of the KT plate ≤ 45° group showed higher survivorship than the inclination angle > 45° group (95.8 vs. 63.6%, P = 0.0047). CONCLUSIONS: With a mean follow-up of 10 years, the clinical and radiographic outcomes were satisfactory. While this study group was small, the results suggest that prosthesis longevity may be improved by setting the inclination angle of this reinforcement device at ≤ 45°.

Preoperative Planning and Operative Techniques of the Shorter Tapered Stem Compared to the Metaphyseal Fit Stem in Cementless Total Hip Arthroplasty.

BACKGROUND: In order to prevent postoperative dislocation due to prosthetic impingement as a result of total hip arthroplasty (THA), the combined anteversion (CA) theory, which combines the anteversion of the femoral stem and the acetabular socket, has been revised in recent years. Particularly, it is necessary to keep CA within the target zone. METHODS: The aim of this study was to investigate whether postoperative CA can be kept within the target zone while using the operative technique which prepares the socket first in cementless THA, by estimating the anteversion of the metaphyseal fit stem or the shorter, tapered wedge stem using preoperative 3-dimensional computerized planning, and by adjusting the anteversion of the socket using a navigation system that considers CA. One hundred fourteen patients (118 hips) were recruited for the study. RESULTS: Postoperative CA in THA using the metaphyseal fit stem was kept within the target zone for 56 of the 60 hips (93.3%). Using the shorter, tapered wedge stem, 49 of the 58 hips (84.4%) were within the target zone. No postoperative dislocations were observed in any hips. CONCLUSION: We found that the metaphyseal fit stem worked better than the shorter, tapered wedge stem in terms of meeting the planned CA. The shorter, tapered wedge stems were flexible in rotation according to the anatomical configuration of the proximal femur. Therefore, the stem could be placed second with the metaphyseal fit stem, but we recommend placing the stem first with the shorter, tapered wedge stem.

Preoperative planning and postoperative evaluation of total hip arthroplasty that takes combined anteversion.

The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more. Clinical assessments were made using the Japanese Orthopaedic Association's (JOA) hip score. For a radiological evaluation, we investigated 3D-planned stem versions, postoperative stem versions, preoperative and postoperative CA, and the relationship between CA and dislocation tendencies with temporary intraoperative reductions. JOA hip scores improved from 52.3 ± 11.4 points to 88.9 ± 8.6 points. CT evaluations revealed that 3D-planned stem versions were strongly correlated with postoperative stem versions (r = 0.80; p < 0.01). Preoperative CA was 50.5° ± 7.2°, and postoperative CA was 41.3° ± 8.6°. Postoperative CA was kept within the safe zone in 61 hips. No intraoperative dislocation tendencies were observed in any hips. By estimating the anteversion of the cementless metaphyseal fit stem using 3D planning preoperatively and adjusting the angle of anteversion of the socket using a navigation system that considers CA intraoperatively, postoperative CA can very frequently be kept within the safe zone, even with cementless THA using the operative technique which prepares the socket first for DDH.

Hand tumors: A review of 186 patients at a single institute.

PURPOSE: The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute. PATIENTS AND METHODS: A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed. RESULTS: There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant (p = 0.031) despite being smaller than other tumors in different body parts. CONCLUSION: When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.

Surgical Treatment of Intramuscular Myxoma.

PURPOSE: Intramuscular myxoma (IM) is a rare benign myxoid tumor that may be challenging to differentiate from sarcoma in small amounts of biopsied material. Although IM appears to be well-circumscribed macroscopically, it infiltrates the adjacent edematous muscle microscopically. The recommended treatment is resection, but there is controversy with regard to the appropriate surgical margin. This study aimed to clarify which surgical procedure that should be applied when the preoperative diagnosis is IM and how to manage treatment if the postoperative diagnosis turns out to be a sarcoma. METHODS: We retrospectively examined 55 IM patients treated from January 1982 to December 2014. Patient characteristics, tumor location, tumor size, radiograph, preoperative and postoperative pathological reports, surgical techniques, treatment outcome, and complications were reviewed. The patients were followed up on for at least 5 years. All patients were confirmed not to have Mazabraud syndrome. RESULTS: In the 55 IM patients examined, the mean patient age was 48 years and most were female. The most common tumor locations were in the muscles of the thighs (47%) and buttocks (20%). The mean tumor diameter was 5 cm. Wide resection and marginal resection were performed in 24 and 31 patients, respectively. The mean follow-up duration was 19 years. No local recurrence, malignant transformation, or complications were observed. CONCLUSIONS: Marginal resection is suitable in patients whose preoperative diagnosis is IM, as it is able to prevent local recurrence and allows for the preservation of muscle and muscle fascia. If the postoperative diagnosis turns out to be myxoid sarcoma, minimum surgical contamination makes additional wide resection less invasive.

Prediction of Soft Tissue Sarcoma from Clinical Characteristics and Laboratory Data.

The accurate diagnosis of soft tissue tumors may be difficult. Simple clinical characteristics or laboratory data that can predict tumor malignancy can be useful tools for diagnosing soft tissue tumors. Between 2003 and 2018, 588 patients with primary soft tissue tumors were retrospectively reviewed. Their clinical characteristics and laboratory data were evaluated to determine their association with the diagnosis of benign, intermediate, or malignant tumor. Multivariable analysis revealed that tumor size ≥ 5.6 cm (odds ratio (OR), 6.15; p < 0.001), white blood cell (WBC) count ≥ 5700/µL (OR, 2.49; p = 0.002), hemoglobin (Hb) count ≤ 12.4 g/dL (OR, 2.56; p = 0.004), C-reactive protein (CRP) level ≥ 0.17 mg/dL (OR, 2.64; p < 0.001), and lactate dehydrogenase (LDH) level ≥ 240 IU/L (OR, 4.94; p < 0.001) were significant predictive factors for sarcoma. The sensitivity and specificity in the presence of three or more predictive factors for detecting malignant tumors were 0.58 and 0.90 respectively, and it was an appropriate threshold with the maximum Youden's index of 0.49. Simple clinical and laboratory data were useful tools for predicting whether the tumor is malignant. Patients with soft tissue tumors that meet any three or more predictive factors should be referred to a specialist.

Computer-assisted anteverting eccentric rotational acetabular osteotomy for recurrent posterior dislocation associated with acetabular retroversion: a case report.

BACKGROUND: Acetabular retroversion is a rotatory abnormality of the entire hemipelvis that includes anterior over-coverage and posterior deficiency of the acetabulum, and is associated with pincer-type femoroacetabular impingement and posterior hip instability. Acetabular retroversion is thought to cause posterior dislocation of the hip in athletes due to both the pincer-type femoroacetabular impingement and posterior hip instability. CASE PRESENTATION: A 26-year-old Japanese man had acetabular retroversion that induced recurrent posterior dislocation of his hip due to excessive hip flexion while wakeboarding. We performed anteverting eccentric rotational acetabular osteotomy using preoperative three-dimensional planning and an intraoperative computerized navigation system. Our patient was able to return to sports activities 1 year postoperatively. CONCLUSIONS: Both preoperative three-dimensional surgical planning software and an intraoperative navigation system can provide a highly accurate map for this complicated surgery that simultaneously improves the pincer-type femoroacetabular impingement and posterior deficiency of the acetabulum.

4-tert-octylphenol regulates the differentiation of C3H10T1/2 cells into osteoblast and adipocyte lineages.

The aim of this study was to investigate whether 4-tert-octylphenol (OP) affects the differentiation of multipotent C3H10T1/2 cells, a cell line established from mouse embryonic connective tissue, into osteoblast and adipocyte lineages. Confluent C3H10T1/2 cells were incubated for 7 days with (OP-treated cultures) or without (control cultures) 15 microg/ml of OP. The 7-day treatment of confluent cells with OP decreased alkaline phosphatase activity by 81%, inhibited the expression of transforming growth factor beta2, and inhibited the morphological changes in cells to an osteoblastic appearance. These results indicate that the 7-day treatment of confluent C3H10T1/2 cells with OP inhibited their differentiation into osteoblasts. Since this treatment strongly induced the expression of peroxisome proliferator-activated receptor r (PPARr) but did not stimulate triacylglycerol (TG) accumulation in cells, C3H10T1/2 cells in the control and OP-treated cultures were incubated for 2 days with a hormone mixture (insulin [INS], dexamethasone, and 1-methyl-3-isobutylxanthine) and incubated for an additional 5 days with INS alone. The TG and adiponectin contents of the OP-treated cultures were 4.2 and 4.1 times higher, respectively, than those of the control cultures. There were many more Oil Red O-staining cells in the OP-treated cultures than in the control cultures. The expression of PPARr in the OP-treated cultures was higher than that in the control cultures. These results indicate that the OP-treated cultures contained a larger number of adipocytes than the control cultures. In conclusion, treatment of C3H10T1/2 cells with OP inhibited osteoblast differentiation, causing a lineage shift toward adipocytes.

Perinatal and postnatal exposure to 4-tert-octylphenol inhibits cortical bone growth in width at the diaphysis in female mice.

The aim of this study was to investigate the effects of 4-tert-octylphenol (OP) on bone growth in vivo. Pregnant mice were exposed to drinking water containing either 1microg/ml OP (LD group) or 10microg/ml OP (HD group) from gestational day 10 and throughout the lactation period. After weaning, the pups were allowed free access to drinking water containing the appropriate OP concentrations. The serum osteocalcin level of the females, but not the males, was significantly lower in the LD and HD groups than in the control group on postnatal day 31. The femurs of the females were analyzed by peripheral quantitative computed tomography and immunohistochemistry for alkaline phosphatase (ALP) was performed in the sections of the formalin-fixed femurs. The periosteal and endosteal circumferences of the cortical bone at the diaphysis were significantly smaller in the LD group, but not the HD group, than in the control group (4% and 6% smaller, respectively), while there were no differences in the cortical bone density, cortical bone area, or cortical thickness among the three groups. There were fewer ALP-positive cells on the periosteal surfaces at the diaphysis in the LD group than in the control group. The values of the strength strain index (xSSI, ySSI, and pSSI) decreased with decreasing the periosteal circumference. In conclusion, the exposure of female mice to OP during the perinatal and postnatal periods inhibited the periosteal bone formation in the cortical bone at the diaphysis of the femur, thereby causing a reduction in bone growth in width.

Perinatal and postnatal exposure to bisphenol a increases adipose tissue mass and serum cholesterol level in mice.

AIM: To investigate whether the perinatal and postnatal exposure of mice to bisphenol A (BPA) caused the development of obesity and/or hyperlipidemia. METHODS: Pregnant mice were exposed to BPA in drinking water at concentrations of either 1 microg/mL (LD group) or 10 microg/mL (HD group) from gestation day 10 and throughout the lactating period. After weaning, the pups were allowed free access to drinking water containing the appropriate concentrations of BPA. The body weight, adipose tissue weight, and serum lipid levels were measured in the offspring at postnatal day 31. RESULTS: In females, the mean body weight increased by 13% in the LD group (p<0.05) and 11% in the HD group (p<0.05) compared with the control group. The mean adipose tissue weight increased by 132% in the LD group (p<0.01). The mean total cholesterol level increased by 33% in the LD group (p<0.01) and 17% in the HD group (p<0.05). In males, the mean body weight and mean adipose tissue weight increased by 22% (p<0.01) and 59% (p<0.01), respectively, in the HD group compared with the control group. The mean triacylglycerol level increased by 34% in the LD group (p<0.05). CONCLUSIONS: The continuous exposure of mice to BPA during the perinatal and postnatal periods caused the development of obesity and hyperlipidemia.

Risk factors for neurological complications after operative treatment for schwannomas.

Schwannoma is a common benign soft tissue tumor. Although schwannomas can be theoretically enucleated without nerve damage, neurological complications occasionally develop following enucleation. The aim of this study was to elucidate the incidence of and risk factors for postoperative neurological complications following schwannoma enucleation. Ninety-eight schwannomas from 95 patients that were treated by surgical excision between January 2003 and December 2014 were included in this retrospective case series study. Patients were 49 men and 46 women with a median age of 60.5years (range, 22-87years). The incidence of postoperative neurological complications was evaluated in all the patients, and characteristics, such as age, tumor size, sex, preoperative symptoms, MRI findings, tumor location, and the nerve of origin, were compared between the cases with or without complications at the last follow-up. In our study population, postoperative neurological complications were observed in 18.4% of the cases. In univariate analysis, preoperative sensory disturbance, tumor location, and the nerve of origin were associated with the incidence of postoperative neurological complications (p<0.001, p=0.034, and p=0.003, respectively). In multivariate analysis, tumors showing preoperative sensory disturbance and tumors located in the proximal aspect of the limbs were identified as independent risk factors for postoperative neurological complications (p<0.001 and p=0.014, respectively). A certain percentage of schwannoma cases undergoing enucleation would show postoperative neurological complications. Therefore, patients with schwannoma, in particular, those with risk factors for postoperative neurological complications, should be informed regarding the possibility of postoperative complications. In cases of schwannoma enucleation, the procedure should be meticulously performed to minimize the damage to the affected nerve of origin.

Bisphenol A Inhibits Cell Proliferation and Reduces the Motile Potential of Murine LM8 Osteosarcoma Cells.

AIM: The aim of this study was to examine the effect of bisphenol A (BPA) on the proliferation and motility potential of murine LM8 osteosarcoma cells. MATERIALS AND METHODS: LM8 cells were treated for 3 days with or without 80 µM BPA. The effect of BPA on cell proliferation was determined by DNA measurement in the cultures and 5-bromo-2'-deoxyuridine (BrdU) incorporation study. Ethanol-fixed cells were stained with hematoxylin-eosin (H&E) to visualize cell morphology. Cell motility was assayed using inserts with uncoated membranes in invasion chambers. Expression of cell division cycle 42 (CDC42) was determined by immunofluorescence staining and western blotting. RESULTS: BPA reduced the DNA content of cultures and the number of BrdU-positive cells. BPA induced a change in morphology from cuboidal with multiple filopodia on the cell surface to spindle-shaped with a smooth cell surface. BPA-treated cells expressed less CDC42 and were less motile than untreated cells. CONCLUSION: BPA inhibited DNA replication and cell proliferation. BPA inhibited filopodia formation and motile potential by inhibiting CDC42 expression in LM8 cells.

Bisphenol A downregulates Akt signaling and inhibits adiponectin production and secretion in 3T3-L1 adipocytes.

AIM: The aim of this study was to investigate whether environmental endocrine-disrupting chemicals, bisphenol A (BPA) and BPA-related chemicals, affect adiponectin production and secretion in 3T3-L1 adipocytes and whether BPA acts through Akt signaling. METHODS: 3T3-L1 adipocytes were treated for 24 h with BPA at various concentrations (20-80 microM) in serum-deprived medium. The medium was filtered through a 0.2 microm filter. Adiponectin in the infranatants of cell homogenates and in the media was measured using an adiponectin ELISA kit. The levels of Akt and p-Akt in cultures treated for 24 h with or without 80 microM BPA were analyzed by Western blot. RESULTS: The control cultures (i.e., BPA was absent during a 24-h treatment period) contained 49.4 microg/mg DNA of adiponectin in the cells and secreted 35.5 microg/mg DNA of adiponectin into the medium. BPA at 80 microM dose-dependently decreased the amounts of intracellular and medium adiponectin by 60% (p<0.01) and 56% (p<0.01), respectively, and decreased the levels of Akt and p-Akt by 46% (p<0.01) and 29% (p<0.01), respectively, compared with the control cultures. Like BPA, bisphenol F (BPF), bisphenol E (BPE), and bisphenol B (BPB) decreased the amounts of intracellular and medium adiponectin. The order of the potential to decrease the amount of intracellular adiponectin was BPB>BPA>BPE>BPF. CONCLUSIONS: BPA downregulates Akt signaling and inhibits adiponectin production and secretion in 3T3-L1 adipocytes.

Ketoprofen in topical formulation decreases the matrix metalloproteinase-2 expression and pulmonary metastatic incidence in nude mice with osteosarcoma.

The aim of this study was to investigate whether ketoprofen (KP) in topical formulation affected the tumor growth and pulmonary metastasis of LM8 cells, which were inoculated subcutaneously into the back space of male nude mice. At 7 days after inoculation, the tumor was treated topically for 3 weeks with either a KP-containing patch (KP group) or a placebo-containing patch (placebo group). The pulmonary metastatic incidence was 100% in the placebo group and 60% in the KP group. The tumor mass of the KP group without pulmonary metastasis, termed the KP/metastasis(-) group, was smaller than that of the placebo group. Immunohistochemical staining for proliferating cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL), matrix metalloproteinase-2 (MMP-2), and vascular endothelial growth factor (VEGF) was performed. The tumors of the KP/metastasis(-) group contained fewer PCNA-positive cells and many more TUNEL-positive cells in comparison to the placebo group. In the placebo group, MMP-2 and VEGF were extensively expressed within the tumor, whereas in the KP/metastasis(-) group the expression of these two proteins was very low. In conclusion, the topical treatment of osteosarcoma with KP decreased the expression of MMP-2 and VEGF, thus resulting in the suppression of tumor growth and pulmonary metastasis.

Diagnostic and therapeutic problems of giant cell tumor in the proximal femur.

Primaly giant cell tumor of bone (GCT) in the proximal femur is relatively rare, and can prove difficult to diagnose, and can require therapeutic methods. Subjects comprised 10 patients (8 males, 2 females). Mean patient age was 27.5 years, and mean follow-up was 89.9 months. Tumors in the present study were limited to H1 and H2 according to the International Society of Limb Salvage (ISOLS) system. All patients received surgical treatment only. Second surgery after preoperative open biopsy was performed for two patients, while the remaining eight patients received excisional biopsy to determine treatment methods using rapid intraoperative pathological examination of frozen sections. The mean functional score was 28.2 out of 30 (93.9%). Local recurrence was observed in two patients. The long-term follow-up reveals that one of the important problem is pre-operative diagnosis. Excisional biopsy is effective for surgery of GCT in the proximal femur.