• 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.
• Take photographs and x-rays if indicated.

• Abnormal areas:  2-3 sections, including the articular surface and subchondral bone.
• Resection margin:  1 section.
• Femoral neck:  1-2 additional sections if tumor is suspected.
• Include synovium and fibrotendinous tissue if present.

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:

#__ - #__ = femoral head, for decal

#__ = femoral neck (margin), for decal

#__ = synovium and necrotic bone, for decal

__ blocks, __ H&E, __ decal.