When Radiology Is Not Enough: Determinants of Surgical Intervention in Proximal Femoral Fibrous Dysplasia
38th Annual Meeting of the European Musculo-Skeletal Oncology Society, Lisbon, Portekiz, 15 - 17 Nisan 2026, (Yayınlanmadı)
- Yayın Türü: Bildiri / Yayınlanmadı
- Basıldığı Şehir: Lisbon
- Basıldığı Ülke: Portekiz
- Ondokuz Mayıs Üniversitesi Adresli: Evet
Özet
Background: The indication for surgical treatment in proximalfemoral fibrous dysplasia (PFFD) remains controversial, particularly in patients demonstrating radiological progressionwithout overt clinical symptoms. This study aimed to identifythe clinical and radiological determinants associated with progression to surgical intervention in patients with PFFD and to assess whether radiological progression alone constitutes a sufficient indication for surgery.
Methods: In this retrospective cohort study, 46 patientsdiagnosed with PFFD between 2004 and 2024 were evaluated. All patients were initially managed conservatively and followed for at least 2 years. Patients who required surgicaltreatment during follow-up (n=18) were compared with thosemanaged non-operatively (n=28). Clinical variables includedpain status and functional impairment. Radiologicalparameters comprised femoral neck–shaft angle (NSA), calcarfemorale involvement, cortical thinning, and the presence of stress reaction or microfracture. The coexistence of at leasttwo radiological risk findings was defined as radiologicalmechanical fragility. Univariate statistical analyses wereperformed.
Results: The median age was 22 years (IQR: 16), and the median follow-up duration was 82.3 months (IQR: 26.5). Surgical treatment was required in 39.1% of patients. Pain and functional impairment were strongly associated with the needfor surgery (p<0.001 and p=0.001, respectively). Advanced varus deformity (NSA <120°) was significantly associatedwith surgical intervention (p < 0.001).While calcar femoraleinvolvement and cortical thinning at diagnosis were not predictive of surgery, the presence of stress reaction or microfracture was significantly associated with surgicalprogression (p=0.028). Radiological mechanical fragilityalone demonstrated limited predictive value. Notably, 42.9% of non-operatively managed patients exhibited silentradiological progression without pain or functional declineand did not progress to surgery during long-term follow-up.
Conclusion: In PFFD, surgical treatment is primarily driven by clinically significant pain and functional impairment ratherthan isolated radiological progression. Advanced varusdeformity and stress reaction/microfracture are essentialmodifiers of surgical risk when accompanied by symptoms. Radiological changes without clinical correlates may be safelymanaged with close observation in selected patients.