As simple as it sounds? The treatment of simple bone cysts in the proximal femur in children and adolescents: Retrospective multicenter EPOS study of 74 patients.

Purpose: Simple bone cysts are among the most prevalent benign cystic tumor-like lesions in children. Proximal femoral simple bone cysts may require specific treatment because of increased fracture risk. With limited literature available on this specific localization, consensus regarding optimal treatment is lacking. We present a large international multicenter retrospective cohort study on proximal femoral simple bone cysts. Methods: All consecutive pediatric patients with proximal femoral simple bone cyst from 10 tertiary referral centers for musculoskeletal oncology were included (2000-2021). Demographics, primary treatment, complications, and re-operations were evaluated. Primary outcomes were time until full weight-bearing and failure-free survival. Results: Overall, 74 simple bone cyst patients were included (median age 9 years (range = 2-16), 56 (76%) male). Median follow-up was 2.9 years (range = 0.5-21). Index procedure was watchful waiting (n = 6), percutaneous procedure (n = 12), open procedure (n = 50), or osteosynthesis alone (n = 6). Median time until full weight-bearing was 8 weeks (95% confidence interval = 0.1-15.9) for watchful waiting, 9.5 (95% confidence interval = 3.7-15.3) for percutaneous procedure, 11 (95% confidence interval = -0.7 to 13.7) for open procedure, and 6.5 (95% confidence interval = 5.9-16.1) for osteosynthesis alone (p = 0.58). Failure rates were 33%, 58%, 29%, and 0%, respectively (p = 0.069). Overall failure-free survival at 1, 2, and 5 years was 77.8% (95% confidence interval = 68.2-87.4), 69.5% (95% confidence interval = 58.5-80.5), and 62.0% (95% confidence interval = 47.9-76.1), respectively. Conclusion: A preferred treatment for proximal femoral simple bone cysts remains unclear, with comparable failure rates and times until full weight-bearing. Watchful waiting may be successful in certain cases. If not feasible, osteosynthesis alone can be considered. Treatment goals should be cyst control, minimizing complications and swift return to normal activities. Therefore, an individualized balance should be made between undertreatment, with potentially higher complication risks versus overtreatment, resulting in possible larger interventions and accompanying complications. Level of evidence: Level IV, retrospective multicentre study.

Do's and Don'ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients.

BACKGROUND: Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs. METHODS: All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated. RESULTS: Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3). CONCLUSIONS: As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Distal Femoral Focal Deficiency.

Distal femoral focal deficiency is an extremely rare type of congenital femoral deficiency that comprises hypoplasia of the distal femur, with a normally developed hip. We represent a unique case of distal femoral hypoplasia and deficiency of knee extensors, childhood follow-up and final treatment with exarticulation, and a comparison with previous literature.

Regular use of traditional analgesics predicts major coronary events: A cohort study.

AIMS: Serious concern has arisen about the cardiovascular safety of selective cyclo-oxygenase-2 (COX-2) inhibitors. However, recent studies have shown that the cardiovascular risks of regular use of traditional analgesics also deserve attention. We investigated the use of traditional analgesics for their prediction of major coronary events during 16 years of follow-up. METHODS: A population sample of 8000 Finns aged 30 years and over was invited to a comprehensive health examination in 1978-1980; 7217 (90%) complied, and 4824 of these had no diagnosed cardiovascular disease. The participants filled in a questionnaire eliciting information on the use of analgesics. Record linkage to the National Hospital Discharge Register and the mortality register of the Central Statistical Office of Finland identified 266 major coronary events (myocardial infarctions or coronary deaths) by the end of 1994. RESULTS: The risk of a major coronary event was significantly elevated among those reporting regular use of analgesics at baseline. Compared with nonusers and adjusted for known risk factors for coronary heart disease, the relative risk of an event during the whole follow-up period was 1.51 (95% confidence interval [CI] 1.08-2.10) among regular users of analgesics. The risk was as high as 5.27 (95% CI 2.13-13.11) during the first two years of the follow-up. Thereafter it leveled off. CONCLUSION: Based on sales statistics almost all analgesics used in Finland at the end of the 1970's were nonsteroidal antiinflammatory drugs (NSAIDs). Therefore, the increased risk of major coronary events among regular users of analgesics is likely to be due to traditional NSAIDs.

Low metacarpal index predicts hip fracture: a prospective population study of 3,561 subjects with 15 years of follow-up.

BACKGROUND: Metacarpal index (MCI), measured from hand radiographs as the ratio between combined cortical thickness and bone diameter, has been suggested for assessment of bone mass and risk of osteoporotic fracture. We studied MCI for its ability to predict hip fractures. METHODS: Hand radiographs were taken and MCI determined in 3,561 subjects from a representative population sample of 8,000 Finns who were 30 years of age or over in 1978-80. Record linkage to the National Hospital Discharge Register identified 117 subjects who had been hospitalized for primary treatment of hip fracture by the end of 1994. RESULTS: High age, low body mass index, tall stature and smoking at baseline showed, independently of each other, significant associations with low MCI. Low MCI was a strong predictor of hip fracture. When adjusted for all potential confounding factors, the relative risk of hip fracture per decrement of MCI by one standard deviation (0.1) was 1.5 (95% CI 1.2-1.8). INTERPRETATION: Low MCI is associated with known risk factors of osteoporosis and predicts hip fracture. Since hand radiographs are easily available at low cost, measurements of MCI can be used as an alternative approach to find osteoporotic individuals with a high risk of hip fracture.

Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality.

BACKGROUND: This study was designed to investigate the prevalence of osteoarthritis in the carpometacarpal joint of the thumb in adults thirty years of age or older in Finland. METHODS: Between 1978 and 1980, a representative population sample of 8000 Finns thirty years of age or older were invited to have a comprehensive health examination; 90% accepted. Hand radiographs were made of 3595 subjects. Since the examination, the subjects have been followed systematically to assess work disability and mortality by reviewing registers covering the whole population. RESULTS: The age-adjusted prevalence of thumb carpometacarpal osteoarthritis of Kellgren grade 2, 3, or 4 was 7% for men and 15% for women. After adjustment for age, sex, and other alleged risk factors, body mass index was found to be directly proportional to the prevalence of thumb carpometacarpal osteoarthritis in both sexes. The adjusted odds ratio was 1.29 (95% confidence interval, 1.15 to 1.43) per 5-kg/m(2) increment in body mass index. No significant association was found between the physical workload history and thumb carpometacarpal osteoarthritis. Restricted mobility of the thumb and local tenderness and swelling were frequently found in conjunction with radiographic evidence of thumb carpometacarpal osteoarthritis. Advanced (grade-3 or 4) thumb carpometacarpal osteoarthritis predicted the total mortality rate in men (adjusted relative risk, 1.32; 95% confidence interval, 1.03 to 1.69). Radiographic signs of thumb carpometacarpal osteoarthritis did not predict work disability. CONCLUSIONS: and CLINICAL RELEVANCE: Obesity is a strong determinant of thumb carpometacarpal osteoarthritis in both sexes. The effect of thumb carpometacarpal osteoarthritis on disability and mortality in the general population is modest. Because of the rarity of ensuing disability, carpometacarpal osteoarthritis of the thumb is likely to be underdiagnosed in clinical practice.

Physical function in men with and without hip osteoarthritis.

OBJECTIVES: To assess the subjective joint pain and function and the objective physical function of lower extremities in men with hip osteoarthritis (OA), to compare the results with those from age- and sex-matched controls, and to evaluate the reproducibility of the functional tests. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Twenty-seven volunteer men (age range, 47-64 y) with hip OA and 30 randomly selected, healthy age-matched men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, passive range of motion (ROM) of the hip joint measured with a standard goniometer, and physical functioning evaluated with a test battery. RESULTS: The function and the composite scores of the WOMAC correlated (P<.05) with the degree of radiographically estimated severity of OA. The hips of the control subjects were 13% to 52% more flexible (P range, <.0001-.001) than those of the OA patients. The more the hip was deteriorated, the lower the ROM of the hip was in abduction and in both internal and external rotations. The reproducibility of marching on-the-spot and walking up and down stairs was good in both groups, but in other functional tests the reproducibility was poorer. The controls were significantly (P range, <.05-.01) better at marching, ascending and descending stairs, performing a 25-m walk, and in flexion-extension and abduction-adduction movements compared with the hip OA patients. Most of the WOMAC items were significantly (P<.05) related to the performance tests. CONCLUSIONS: The WOMAC and the ROM can be considered useful hip OA indicators. Marching on-the-spot and walking up and down stairs are the most reproducible physical functioning tests and can thus be recommended for use for patients with hip OA.

Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis.

OBJECTIVE: To study the hip muscle strength and cross sectional area (CSA) in men with hip osteoarthritis (OA) compared to age and sex matched healthy controls. METHODS: Based on the American College of Rheumatology criteria regarding classification of hip OA, 27 men (aged 47-64 yrs) with unilateral or bilateral hip OA and 30 age matched randomly selected healthy male controls were studied. The maximal isometric hip abductor, adductor, flexor, and extensor strength (Nm) at 0 degree of hip flexion in the supine position was determined with a dynamometer. The isokinetic hip flexion and extension strength (peak torque, Nm) was determined using angular velocities of 60 degrees /s and 120 degrees /s. The subjective severity of hip pain was rated by visual analog scale prior to the muscle strength test. CSA of the pelvic and thigh muscles was measured from magnetic resonance images. RESULTS: The reliability of intraclass correlation coefficients for repeated measures of muscle strength varied from 0.70 to 0.94 in controls and from 0.84 to 0.98 in subjects with OA. Hip isometric adductor and abductor strength was 25% and 31% lower (p < 0.001) in OA subjects than in controls, respectively. The hip isometric and isokinetic flexion strength was 18-22% lower (p < 0.01) in OA subjects than in controls, but extension strength did not differ between groups. In OA subjects, the hip flexion and extension isometric and isokinetic strength values were 13-22% lower (p < 0.05) on the more deteriorated side compared to the better side. CSA of the pelvic and thigh muscles did not differ between the groups. However, in OA subjects, the CSA of the pelvic and thigh muscles was 6-13% less (p < 0.05 to < 0.001) on the more severely affected hip compared to the better hip. CONCLUSION: Men with hip OA have significantly lower abduction, adduction, and flexion muscle strength than controls. The decrease of muscle size and hip pain may contribute to the decrease of muscle strength in hip OA. Other possible underlying causes of the muscle weakness need to be studied.