Osteoarthritis of the hip in fibrous dysplasia of the proximal femur

Abstract

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.

The Modified West China Hospital Radiographic Classification for Fibrous Dysplasia in Femur: A Retrospective Analysis of 238 Patients

“…The deformities of the femoral shaft, coxa vara, and genu valgum, are signi cantly associated with the degeneration of the hip and knee. Additionally, polyostotic FD is found to be more prevalent in hip arthritis than monostotic FD [38,39]. In our study, type V patients had signi cantly higher Guille scores than type III and IV, but no signi cant difference was found between patients with type V and those types I and II.…”

The Predictive Factors of Fracture in Patients with Fibrous Dysplasia of Proximal Femur

“…In a retrospective study, Han thought that the peak age of fractures in patients with proximal femoral brous dysplasia was bimodal. The rst peak is between 6 and 10 years old, and the second peak is after 36 years old [25] .…”

Total hip arthroplasty in patients with fibrous dysplasia: a modern update

“…1 A significant number of these patients will require THA in their lifetime. 3 Unfortunately, there is a lack of literature reporting the results and complications of this surgery in FD patients with modern implant technology and techniques. Furthermore, there is minimal guidance for surgeons treating these challenging cases.…”

“…1 Twelve percent of patients with FD will develop osteoarthrtitis of the hip and may require total hip arthroplasty (THA) during their lifetime. 3 These cases represent a significant technical challenge to orthopedic surgeons because of poor bone quality and deformities resulting from the disease. Unfortunately, there is very little information on best practices to guide management of these cases.…”