Death, taxes and trapeziometacarpal arthrosis

Becker, et al.

CORR (2013) 471:3738–3744

The authors wanted to substantiate the notion that trapeziometacarpal arthrosis is a normal human ageing process and that most people never seek medical attention despite the seeming frequency with which patients present for medical treatment. Between 2002 and 2012, 2321 patients 31 years or older with radiographs obtained for treatment of a distal radius fracture were analyzed. The prevalence increased to 85 % between the ages of 71 and 80 years and reached 100 % in women (with 50 % classified as severe) aged 91 years or older and 93 % in men 81 years or older. Logistic regression identified higher age and gender as the strongest factors for trapeziometacarpal arthrosis.

The natural history of inflammatory pseudotumors in asymptomatic patients after metal on metal hip arthroplasty

Almousa SA, et al.

CORR (2013) 471, 12 3814–3821

Inflammatory pseudotumors have been reported in 32 % of asymptomatic metal on metal hips. Their natural history is unknown. Using ultrasound for a mean of 25.8 months after the detection of 15 psuedotumors and five fluid collections in a cohort of 20 asymptomatic patients (13 metal on metal, four hip resurfacing and three metal on polyethylene) the pseudotumors increased in size in six, three disappeared, and one decreased in size. In five other patients whose pseudotumors developed after revision, there was complete disappearance in four. Four of the five fluid collections completely disappeared. The authors recommend that isolated fluid collections be observed with ultrasound follow-up, anticipating complete disappearance. For solid and or cystic masses surgical intervention is recommended only if the mass substantially increased in size on ultrasound.

Asymptomatic pseudotumors after metal on metal hip resurfacing show little change within one year

Vander Weegen W, et al.

Bone and Joint J. 2013 Dec;95-B(12):1626–31

The authors used metal artifact reduction sequence (MARS) – MRI, serum metal ion analysis and clinical examination to study 14 unrevised hips with a pseudotumor and 23 hips without a pseudotumor. The first MARS-MRI was performed at a mean of 4.3 years and the mean time between the first and second was eight months. At the second MRI scan the grade of severity of the pseudotumor had not changed in 35 hips, one new pseudotumor was observed and one was downgraded and in the rest there was no change. The authors state that this is the first longitudinal study on the natural history of pseudotumors using MARS-MRI. The authors speculate that the lack of clinically relevant change, in contrast to the preceding paper abstracted in this Browser’s Notes, may be related to the shorter follow-up in this study (mean of eight months versus 25.8 months). The authors add that, a-symptomatic pseudotumors can be overlooked in the absence of screening but there is a risk of overtreatment based on MRI findings.

Abstracted by M. Sundaram, M.D.

May 2014