A femoral cyst is a benign neoplasm in the form of a cavity inside one or another of its parts. It is filled with serous fluid or blood, and its surface is lined with a connective tissue membrane. The femur is the second most common bone affected by cysts. It accounts for about 25% of all cases of diagnosing such neoplasms. They are usually found in children 5-15 years old, but can also be diagnosed in adults and older people, especially those suffering from arthrosis of the hip, knee joints and other diseases of the musculoskeletal system.
Types of femoral cysts
The femur consists of a diaphysis (body), proximal and distal epiphyses (heads), as well as adjacent metaphyses (necks). A cystic cavity can form in each of them, on the basis of which a cyst of the femoral head, body and metaphysis is distinguished. Moreover, such formations can be present only in one limb, in both, or even in several bones of the skeleton. The epiphyses of the femur form the largest joints of the human body: the proximal one is the hip joint, the distal one is the knee joint. Therefore, the location of the tumor determines whether the symptoms will be present in the knee area or observed from the groin and hip joint.
There are 3 main types of cystic formations found in the femur:
- solitary;
- aneurysmal;
- subchondral.
In children, formations of the first two types are usually diagnosed. A femoral cyst in adults may be a previously undiagnosed solitary, aneurysmal cyst, but more often it is subchondral.
Installation of the acetabular cup
A series of X-rays are taken, in which it is important to correctly identify and evaluate the signs of arthrosis, since, for example, different methods of fixing endoprostheses are used for dysplastic and hyperplastic coxarthrosis. Sclerosis and cysts directly influence the choice of arthroplasty technique, in particular the method of cup attachment. It is impossible to integrate the coating of a cementless cup into sclerotic bone that has lost its elasticity.
For a more reliable fixation of the cup, the cavity is cleaned down to the level of the spongy substance, since this tissue is able to effectively participate in the process of osseointegration. Cement fixation is also more stable when placed on a spongy substance. It is important to remove as much sclerotic tissue as possible.
After treating the surface of the acetabulum with special cutters, holes for attaching the cup are drilled to the level of the spongy substance, and all cystic formations are cleaned out. The cavities remaining after curettage are filled with a substance obtained either from the head of the femoral bone or from the bone canal. The cavity is washed, tamponed, and a cup is installed. When planting on cement, the required thickness of the mantle layer under the bowl is taken into account.
If a cup of cementless fixation is installed in the presence of cysts, then after all the stages of cleansing the surface of the cavity from osteophytes and scraping out the cystic cavities, the remaining defects are filled with spongy autologous bone - a substance extracted from the head, as well as remaining during the treatment of the medullary canal. The substance is compacted at the bottom of the depression, strengthening it. If the patient’s own autologous bone is not enough, then a special synthetic hypoallergenic material is used. In order to increase reliability, the bowl is additionally secured with screws.
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Solitary
Solitary cysts are more common in children. They predominantly affect the proximal metaphysis of the femur and do not extend beyond the boundaries of the cartilaginous epiphyseal line. These lines are located immediately behind the epiphysis and represent the bone growth zone in children. Their cells are in the process of constant mitotic division until the completion of the formation of the skeleton, which ensures the growth of the bone in length. The newly formed cartilage cells move further away from the epiphysis and are replaced by osteoblasts, thereby forming new bone tissue. Solitary cysts are always single-chamber and filled with serous fluid. They are diagnosed 3 times more often in boys.
Types of formations
There are different types of articular cysts. The most common diagnosis is synovial. It arises from the synovial membrane, and its contents become the fluid it produces. The walls are elastic and do not communicate with the skin and fatty tissue.
Another type is a bone cyst. It is more dangerous because as it grows it provokes the destruction of bone tissue and is more difficult to treat. Its formation is facilitated by the processes of protein breakdown, provoked by malfunctions in the body.
Also, joint cysts can be single or multiple. In the second case, a large formation is more often observed, divided into several chambers. Joint damage can be unilateral or bilateral, which is mainly associated with the cause of the development of the pathology.
Subchondral
Subchondral cysts are cystic cavities in the epiphyses of the femur, formed as a result of degenerative changes in the knee or hip joint. Usually these are multiple formations that differ in size and shape. A characteristic feature of subchondral cysts is their location directly under the hyaline cartilage covering the distal or proximal epiphysis of the femur. They always accompany arthrosis, arthritis of the knee or hip joint, as well as avascular necrosis. And their symptoms are practically indistinguishable from the clinical picture of these pathologies.
Less commonly, juxtaarticular cysts or intraosseous ganglion are found in adults. It is also formed in the subchondral parts of the bone, but has a multi-chamber structure.
Reasons for development and types
Similar neoplasms occur in both children and adults. In children, a bone cyst of the hip joint is usually one of the solitary, i.e., single-chamber cavities filled with serous fluid and located under the cortical layer of the bone. With active growth, they can provoke “swelling” of the bone, which causes the appearance of characteristic symptoms.
The reasons for their development have not yet been fully established, but it is assumed that they are a consequence of impaired blood flow in the bones. This provokes an increase in intraosseous pressure in certain areas and destruction of bone beams. As a result, a cavity is formed, which is filled with interstitial fluid. Solitary cysts are usually diagnosed in adolescents, although sometimes they are first discovered in people in adulthood.
Also, the pelvic bones are often affected by aneurysmal cysts. Unlike solitary ones, they are multi-chambered and filled with blood. Such neoplasms are prone to rapid growth with the development of joint dysfunction. The reasons for their development have not been precisely established, but the influence of a vascular factor is also assumed, although the possibility of formation against the background of trauma cannot be ruled out. Aneurysmal cysts are typical for both children and adults, but are more often diagnosed before the age of 20.
Cysts of the pelvic bones, or, as patients say, a cyst of the hip bone in an adult, are most often subchondral. They are located directly under the articular surface of the femur or acetabulum, covered with a layer of hyaline cartilage. Such neoplasms are a consequence of degenerative changes and inflammatory processes in the joint, as well as often accompanying aseptic necrosis of the femoral head. It can become a consequence of progressive arthrosis, arthritis, osteomyelitis, etc.
Symptoms
A bone cyst of the femur can be asymptomatic for a long time, especially if it is small in size. But as it grows, characteristic symptoms usually appear on the side on which the tumor is observed. So, with a cyst of the left femur, characteristic signs will be present on the left side, with a cyst of the right femur, respectively, on the right. This:
- transient aching pain in the knee or groin area, which tends to occur and intensify with physical activity;
- transient lameness, gait disturbances with the leg turned outward;
- stiffness of movement, limited mobility;
- the formation of a swelling that is not fused to the skin, sometimes painful (usually in the area of the knee joint);
- decreased support function of the affected limb.
Initially small cysts can eventually reach enormous sizes, even spreading over the entire cross-section of the bone. Sometimes this provokes deformation of the hip or the affected joint without shortening the bone, but with the formation of a thickening in the area of the cavity.
The most pronounced symptoms are characteristic of aneurysmal and subchondral cysts.
Often the first manifestation of the disease is a pathological fracture. Moreover, it can be obtained as a result of the action of a factor that, under normal conditions, cannot lead to a violation of the integrity of the bone. As a result, when performing an X-ray diagnosis of a fracture, the cystic cavity is discovered by chance and explains the reasons for the injury.
For older people, fractures are especially dangerous, especially of the femoral neck. They may require surgery, which cannot always be performed due to contraindications. Therefore, such injuries often cause disability.
At the limit: hip joints and excess weight
The hip joints in the body undoubtedly bear one of the heaviest loads. Therefore, it is not surprising that excess weight is one of the factors of their destruction. However, coxartosis is not observed in all obese patients. So what other “joint” risk factors should you keep in mind if you are overweight?
Excess weight as a factor of “exhaustion”
As already noted, excess weight literally “presses” and “compresses” the hip joints, provoking their injuries and the development of inflammation.
At the same time, normally all cartilages are distinguished by a perfectly smooth surface and elastic structure, which allows them to most effectively and safely perform the function of a “shock absorber” when walking, jumping and other “axial” loads.
Such qualities are ensured due to the special structure of chondrocytes (cartilage cells) and the substances they synthesize: collagen, hyaluronic acid, glycosaminoglycans and proteoglycans. However, with chronic trauma, the ability of chondrocytes to synthesize the latter is greatly depleted, due to the increased costs of “repairing” the damage.
This leads to disruption of cartilage restoration, the formation of some “scar” tissue and a decrease in their elasticity. Which dramatically increases the negative impact of constant “overloads”, and, over time, leads to the complete destruction of the cartilage tissue of the joints.
Among the early symptoms accompanying this process:
- "shooting" pains,
- pain after exercise that goes away with rest
- pain when squatting or certain body positions
Without treatment, the destruction gradually “moves” to the bone, and this disease is called “osteoarthrosis” (or coxarthrosis) and is characterized by irreversible damage, leading to disability and the need for prosthetics.
Obviously, it would be “good” to identify such pathologies at the earliest possible stages, when, for example, the use of chondroprotectors can give a noticeable clinical effect. However, for this, if you are overweight, you should keep in mind some other significant risk factors.
Who's at risk
1. Age-related changes open up a risk group for coxarthrosis. After all, a decrease in the synthesis of collagen, hyaluronic acid and other “elasticity” factors is natural for the aging process.
In addition, with age, vascular disorders appear, which reduces the nutrition of cartilage and provokes degenerative processes.
2. Injuries and/or joint surgeries.
The risk of arthrosis in the future sharply increases even minor, invisible microtraumas of cartilage (for example, during sports). So former athletes and traumatologist patients constitute another risk group for the disease.
3. Heredity.
Here we are talking not only about pathologies of the hip joints themselves, but also of the articular apparatus as a whole in close relatives. As well as pathologies of connective tissue (for example, dysplasia) or muscular apparatus (weakening the fixation of joints).
4. Concomitant diseases:
- metabolic diseases that change the structure of joints (gout and others);
- weakening of the muscular system (for example, myopathy);
- connective tissue diseases (usually autoimmune in nature: systemic lupus erythematosus, scleroderma and others).
“Control” analyzes
Osteoarthritis is a diagnosis for which the main role is played by x-ray examination of joints or MRI.
Blood tests for coxarthrosis, to a greater extent, are of an auxiliary nature, and are used in an attempt to find out the “initial” cause, and therefore the direction of treatment, for this pathology in each individual patient.
1. Clinical blood test. They allow one to assess the presence of a systemic inflammatory response, which is characteristic, to a greater extent, of the rheumatological origin of symptoms.
2. Blood test for C-reactive protein. Correlates with the severity of the inflammatory process in various joint diseases.
3. Blood test for uric acid. Allows you to exclude gout as a cause of disorders.
Diagnostics
If symptoms of a femoral bone cyst appear, you should contact an orthopedic traumatologist. The doctor examines the patient, performs tests to assess range of motion, and palpates the affected area. If a tumor is suspected, an x-ray is required. The resulting images usually make it possible to accurately diagnose a cystic cavity and determine not only its size, but also its appearance. It is also possible to detect signs of bone swelling and thinning of the cortical layer.
Sometimes, to clarify the diagnosis, ultrasound of the hip or knee joint, CT and MRI are additionally prescribed.
Treatment of femoral cyst
In some cases, a pathological fracture and its subsequent fusion causes the defect to close. But it should not be considered as a way to get rid of a cyst. In such cases, the cavity may not only not completely close, but also continue to increase in size, becoming more aggressive. The most effective treatment for femoral cysts is surgery. But it is carried out only if there is strong evidence. In other cases, conservative therapy is prescribed, especially when diagnosing bone cysts in children.
Conservative therapy
Non-surgical treatment gives the best results in children, since due to their age, reparative processes are more active and complete. It involves taking NSAIDs to reduce pain and suppress inflammation, exercise therapy, and sometimes physical therapy. Adult patients with subchondral cysts must be treated for the underlying disease that has caused the formation of a cavity in the bone tissue.
The main method of conservative treatment of bone cysts is puncture. This is an invasive procedure performed under local anesthesia. Its essence is to insert a needle into the cavity formed inside the bone and aspirate the liquid contents. If the tumor is localized in a hard-to-reach place, for example, in the hip joint, the needle is guided under CT control.
After the fluid is removed, the cyst walls are punctured and the cavity is washed with saline solution. This is necessary to cleanse it of enzymes and bone tissue breakdown products, as well as neutralize the process of fibrinolysis. The last stage of the procedure is the injection of drugs with antiproteolytic properties, sometimes corticosteroids, into the cyst.
The number of punctures in each case is determined individually. Solitary cysts are punctured less frequently, on average once every 2-4 weeks, aneurysmal cysts - every 7-10 days. The effectiveness of treatment is monitored through x-ray diagnostics.
In most cases, conservative treatment avoids surgical intervention, and after 2 months of therapy, a decrease in the size of the tumor is observed. But it may take 1-2 years to completely restore the normal structure of the femur.
Rehabilitation
The rehabilitation period is no less important than the proper execution of joint replacement surgery. Not all clinics offer a full program, limiting it to a few days, and patients are often not conscious enough to continue the recovery complex on their own. Therefore, after the operation, it is recommended to go to a specialized sanatorium, or it is better to have a joint replacement performed in a clinic, which guarantees not only high-quality endoprosthetics, but also provides a full rehabilitation course.
All this can be guaranteed by specialized medical institutions in the Czech Republic, where the high professionalism of doctors, the European level of service provision and the availability of natural resources for the restoration of the musculoskeletal system are combined with low prices for Europe. For many years, he has been organizing treatment for patients from the Russian Federation with orthopedic problems in the best clinics in the Czech Republic. The client receives full information support, assistance in paperwork and transportation. All financial issues are discussed in advance, the results are fixed in the contract and no longer change throughout the entire process of treatment and rehabilitation.