The vast majority of femoral heads are resected due to osteoarthritis or fracture. The specimen usually includes femoral head and a short segment of femoral neck. Pathological features of osteoarthritis include thinning of articular cartilage, subchondral bone formation and cystic change, and osteophyte formation at the cartilage-bone junction. Major differential diagnoses for femoral neck fracture should include avascular necrosis, osteoporosis, metastatic carcinoma (esp. breast and prostate), and degenerate joint disease (osteoarthritis). Review recent imaging (x-ray/CT/MRI) results to guide sampling if necessary.
The most important thing when grossing a femoral head is to avoid injuring yourself. Seek help if you are not familiar with the electric saw.
Examine the articular surface (e.g. smooth, irregular) and femoral resection margin.
Measure the diameter of the head and length, diameter, and cortical thickness of the neck.
Serially section through the femoral head in the coronal plane at 3-5 mm intervals with a band saw.
Examine the cut surface for subchondral bone formation, cystic change, thinning of articular cartilage, bone trabecular density, and tumor.
Received without fixative/in formalin, labeled _____ and "_____" is an intact femoral head with/without femoral neck. The femoral head measures __ cm in diameter and __ cm in height, and the neck measures __ cm in length with a maximum diameter of __ cm and a compact cortex of __ cm in greatest thickness. The articular surface is _____ (color, smooth vs. rough) with _____ (e.g. marked central thinning, erosion at the edge). Hyperplastic synovial villi are/are not seen. There are/are no osteophytes at the cartilage-bone junction. The articular cartilage measures __ cm in thickness with _____ (e.g. marked central thinning). The subchondral bone is _____ (color, dense vs. porous) with _____ (e.g. a subchondral cyst of __ cm, marked thinning of bony trabeculae, necrotic change near the femoral head). There is/is no hemorrhage, soft tissue mass, or osteoporotic change at the resection margin. A/no periosteal reaction or mass is noted. The distal resection margin is ____ (e.g. color, fatty, normally trabeculated, hemorrhagic). Representative sections are submitted as follows: