Deformity of the proximal femur in fibrous dysplasia
leads to deviation of the mechanical axis of the hip, which may lead
to the development of secondary osteoarthritis (OA). This study
investigated the prevalence and predisposing factors for the development
of OA in patients with fibrous dysplasia of the proximal femur.
We reviewed the records of 209 patients from our institutional database
with fibrous dysplasia of the proximal femur, investigating possible predisposing
factors including patient demographics, the extent of the coxa vara
deformity, the presence of peri-articular disease, and the overall
burden of skeletal disease. Of the 209 patients, 24 (12%) had radiological
evidence of OA in the ipsilateral hip. The prevalence was significantly
higher in patients with polyostotic fibrous dysplasia compared with
those with monostotic disease (p <
0.001). In a subgroup analysis of
patients with polyostotic disease, the extent of deformity (quantified
using the neck–shaft angle), and the presence of peri-articular
disease (whether in the head of the femur or the acetabulum) were
significant predictors of osteoarthritis (neck–shaft angle likelihood
ratio (LR) = 0.847 per 1° increase, p = 0.004; presence of lesion
in the head of the femur LR = 9.947, p = 0.027; presence of lesion
in the acetabulum LR = 11.231, p = 0.014). Our data suggest that patients with polyostotic fibrous dysplasia
have a high risk of developing secondary OA of the hips. This risk
is higher in patients with peri-articular disease, and those with
a more severe deformity of proximal femur. Cite this article:
We reviewed nine patients at a mean period of 11 years (6 to 16) after curettage and cementing of a giant-cell tumour around the knee to determine if there were any long-term adverse effects on the cartilage. Plain radiography, MRI, delayed gadolinium-enhanced MRI of the cartilage and measurement of the serum level of cartilage oligomeric matrix protein were carried out. The functional outcome was evaluated using the Lysholm knee score. Each patient was physically active and had returned to their previous occupation. Most participated in recreational sports or exercise. The mean Lysholm knee score was 92 (83 to 100). Only one patient was found to have cartilage damage adjacent to the cement. This patient had a history of intra-articular fracture and local recurrence, leading to degenerative changes. Interpretation of the data obtained from delayed gadolinium-enhanced MRI of the cartilage was difficult, with variation in the T1 values which did not correlate with the clinical or radiological findings. We did not find it helpful in the early diagnosis of degeneration of cartilage. We also found no obvious correlation between the serum cartilage oligomeric matrix protein level and the radiological and MR findings, function, time after surgery and the age of the patient. In summary, we found no evidence that the long-term presence of cement close to the knee joint was associated with the development of degenerative osteoarthritis.
