Fate of patients with slipped capital femoral epiphysis (SCFE) in later life : risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Background and purpose - Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE. Patients and methods - 2,564 patients diagnosed with SCFE at age 5-16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals. Results - The risk of obesity (HR 9, 95% CI 7-11) and hypothyroidism (HR 3, CI 2-4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1-1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1-2). The incidence of SCFE did not increase over the past decades. Interpretation - Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates

Legg-Calvé-Perthes Disease – Is it just the hip? : Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood. Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality. In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995. The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes. Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD. Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes

Legg-Calvé-Perthes Disease – Is it just the hip? : Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood. Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality. In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995. The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes. Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD. Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes

Legg-Calvé-Perthes Disease – Is it just the hip? : Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood. Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality. In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995. The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes. Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD. Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes

No increased mortality after total hip arthroplasty in patients with a history of pediatric hip disease : a matched, population-based cohort study on 4,043 patients.

Background and purpose - Patients with pediatric hip diseases are more comorbid than the general population and at risk of premature, secondary osteoarthritis, often leading to total hip arthroplasty (THA). We investigated whether THA confers an increased mortality in this cohort.Patients and methods - We identified 4,043 patients with a history of Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), or developmental dysplasia of the hip (DDH) in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2012. For each patient, we matched 5 controls from the general population for age, sex, and place of residence, and acquired information on all participants' socioeconomic background and comorbidities. Mortality after THA was estimated according to Kaplan-Meier, and Cox proportional hazard models were fitted to estimate adjusted hazard ratios (HRs) for the risk of death.Results - Compared with unexposed individuals, patients exposed to a THA due to pediatric hip disease had lower incomes, lower educational levels, and a higher degree of comorbidity but a statistically non-significant attenuation of 90-day mortality (HR 0.9; 95% CI 0.4-2.0) and a lower risk of overall mortality (HR 0.8; CI 0.7-0.9).Interpretation - Patients exposed to THA due to a history of pediatric hip disease have a slightly lower mortality than unexposed individuals. THA seems not to confer increased mortality risks, even in these specific patients with numerous risk factors

High blood pressure and overweight in children with Legg-Calvé-Perthes disease : a nationwide population-based cohort study

Purpose: Legg-Calve-Perthes disease (LCPD) and its association with cardiovascular diseases, obesity and hypertension has been consistently observed but remains cloudy. This study aimed to investigate the presence of hypertension and overweight/obesity at diagnosis of LCPD and at a 2-year follow-up and its association with age, sex and lateral pillar classification. Method: We compared blood pressure (BP) (n=93) and body mass index (BMI) (n=125) in patients registered in the Perthes' register - a part of the Swedish pediatric orthopedic quality register (SPOQ) - with normative data for children with the same age and sex. Results: In children with LCPD 19% had high BP. At the 2-year follow-up, 13% had high BP. For children with LCPD, 30% were either overweight or obese. At the 2-year follow-up, 32% were either overweight or obese. Paired analysis showed stable BMI z-score between these 2 measurements. The sample size of this study was too small to analyze possible associations of high BP or BMI with age, sex and lateral pillar classification. Conclusions: The prevalence of hypertension was higher in children with LCPD compared to general pediatric normative data. The same pattern was seen for overweight/obesity. Further studies are needed to investigate whether BP and obesity are catalyzing factors in the etiology of LCPD

Similar risk of cancer in patients younger than 55 years with or without a total hip arthroplasty (THA) : a population-based cohort study on 18,771 exposed to THA and 87,683 controls

Background and purpose - Concerns related to a potentially increased risk of cancer after total hip arthroplasty (THA) have frequently surfaced, especially since the novel EU medical device regulation classified cobalt as carcinogenic. We assessed the risk of cancer after THA in a nationwide cohort of patients younger than 55 years at surgery. Patients and methods - In this population-based longitudinal cohort study, 18,771 individuals exposed to THA were identified in the Swedish Hip Arthroplasty Registry (SHAR) and compared with 87,683 unexposed individuals who were matched by age, sex, and residence. Diagnoses, socioeconomic background, and dates of death were obtained from the Swedish Cancer Register, the National Patient Register, and Statistics Sweden. Primary outcome was the adjusted risk of any cancer after the first THA; secondary outcomes were specific cancer forms. Results - We found no enhanced adjusted risk of developing any cancer, either in exposed females compared with unexposed females (hazard ratio [HR] 1.1, 95% confidence interval [CI] 0.95-1.2), or in exposed males (HR 1.1, CI 0.99-1.2). When analysing specific cancers, increased adjusted risks were found for thyroid and pancreas cancer in exposed females, and for cancer of the stomach, skin melanoma, and prostate cancer in exposed males. Interpretation - This study indicates that there is no statistically significant increased overall risk of cancer in young THA-exposed patients. The potentially slightly enhanced risk for specific cancers may be due to residual confounding resulting from risk factors not accounted for and merits further investigation

Epidemiology of pediatric femur fractures in children : the Swedish Fracture Register

BACKGROUND: Although femur fractures in children are rare, they are the most common fractures in need of hospitalization. We sought to describe the epidemiology and treatment of pediatric femur fractures recorded in the Swedish Fracture Register (SFR). We also studied the relationship between femur fractures, age, sex, fracture pattern, injury mechanism, seasonal variation and treatment. METHODS: This nationwide observational register study was based on the pediatric part of the SFR. We included all patients &lt; 16 years of age who were registered in the SFR from 2015 to 2018. RESULTS: Of the 709 femur fractures, 454 (64%) occurred in boys. Sixty-two of these fractures were proximal (9%), 453 shaft (64%) and 194 distal (27%). A bimodal age distribution peak was observed in boys aged 2-3 and 16-19 years. In contrast, the age distribution among girls was evenly distributed. Younger children were mainly injured by a fall, whereas older children sustained their fracture because of traffic accidents. Non-surgical treatment prevailed among younger children; however, prevalence of surgical treatment increased with age. CONCLUSIONS: We found a lower ratio between boys and girls (1.8:1) compared to earlier studies. The bimodal age distribution was seen only in boys. Falls were the most common injury in younger children, whereas traffic-related accidents were the most common in adolescents. With age, there was a corresponding increase in surgical treatment.De två sista författarna delar sistaförfattarskapet</p

Recommendations for physiotherapy and physical activity for children with Legg–Calvé–Perthes disease: a survey of pediatric orthopedic surgeons and physiotherapists in Sweden

Background and purpose: Physiotherapy, restrictions of physical activity, and weightbearing are part of the treatment of children with Legg–Calvé–Perthes disease (LCPD). Prescription practices are widely discussed and vary between pediatric orthopedic surgeons (POSs) and physiotherapists (PTs). The purpose of this study was to identify recommendations for treatment methods in clinical practice to find some consensus and elaborate guidelines. Patients and methods: A web-based questionnaire including 3 cases of LCPD (initial, fragmentation, and reossification stages) was answered by 25 POSs and 19 PTs. They were asked to describe their preferred recommendations for physiotherapy, including stretching, strengthening, weightbearing, and physical activities in relation to, e.g., range of motion (ROM) pain, sex, and disease stage. Results: ROM was considered to be important when recommending physiotherapy; PTs also recognized pain and disease stage. Sex was reported as a factor with low importance. Stretching exercises were recommended for all disease stages. Recommendations for strengthening exercises varied for the initial and fragmentation stages. None of the participants recommended total non-weightbearing. Most restricted trampolining, running, ball sports, and gymnastics in the first 2 stages of the disease and allowed swimming, short walks, cycling, and horse riding without restrictions for all stages. Conclusion: We found high agreement on recommending stretching exercises for all disease stages, but controversies regarding recommendations for strengthening exercises in the initial and fragmentation stages. No non-weightbearing treatment for the affected hip was recommended by any participants at any stage of the disease. There was no clear consensus regarding the appropriate timeline for resuming full activities

Expanding the phenotypic spectrum of osteogenesis imperfecta type V including heterotopic ossification of muscle origins and attachments

Background Osteogenesis imperfecta (OI) is a clinical and genetic heterogeneous group of connective tissue disorders, characterized by bone fragility and a propensity to fracture. Methods In this report we describe the clinical phenotype of two patients, a 28‐year‐old woman and her mother (54 years old), both with a history of short stature and multiple fractures. Results Exome sequencing revealed the recurring IFITM5:c.‐14 C&gt;T variant causing OI type V. Both patients had several fractures during childhood. CT‐scan and scintigraphy showed ossification of the origin and attachment of muscles and hypertrophic callus formation. Conclusion Ossification of the origin and attachment of muscles seems to be part of the phenotype in patients with OI type V