Purpose: To perform a systematic review and meta-analysis of literature and to evaluate the relationship between abnormal femoral version and the development of hip osteoarthritis (OA). Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluating Level I and II studies. Included studies had to provide granular femoral version (FV) information. The severity of OA was ranked on the KellgreneLawrence (KL) scale. Excel version 1808 (Microsoft, Redmond, WA) was used to perform a student t test statistical analyses. Results: Our review identified 19 qualifying studiesd5 Level I and 14 Level II with 1,756 patients. Patients with FV above normal range (>14 ) had greater KL scores than patients with normal range FV (mean AE standard deviation; 3.37 AE 1.44 vs 2.05 AE 1.72, P < .05). Analysis of KL scores in patients with FV >24 (>1 standard deviation) versus patients with FV >14 but <24 also demonstrated a positive correlation between increasing FV and KL (4.00 AE 1.96 vs 2.34 AE 0). This was significant independent of the presence or absence of developmental dysplasia of the hip. Retroverted hips (FV<10 ) in the present study showed variable OA results upon analysis. Conclusions: The present review suggests that elevated FV may be a risk factor for more severe hip OA with or without the presence of concurrent dysplasia of the hip. The relative amount of increased anteversion appears positively correlated with severity of OA. Although femoral retroversion may impact hip mechanics, in this review it does not appear to strongly correlate with the development of OA. Level of Evidence: II: systematic review of Level I and II studies.

Background and Objectives: Sarcoma local recurrence (LR) is often associated with metastasis, but it is unclear if LR can be a causal event leading to metastasis. We question if LR is best viewed as an independent oncologic event or as a worrisome harbinger threatening a patient's overall survival. Methods:We identified patients with LR and/or metastasis from an ongoing cohort of 629 patients with primary sarcoma and performed a detailed review to assess the timing of metastasis resulting in the following groups: (1) Isolated LR, (2) LR before metastasis, (3) LR within 6 months of metastasis, (4) LR 6-12 months after metastasis, (5) LR >12 months after metastasis, and (6) metastasis at diagnosis.Results: Overall, 43 patients met the inclusion criteria with an LR rate of 7%. Ten patients (2% of the entire cohort, 23% of LR) developed an LR before or within 6 months of metastasis. For patients without systemic disease preceding LR, 3 of 23 soft tissue sarcoma STS (13%) and 7 of 10 bone sarcoma (70%) subsequently developed metastasis (p < 0.01). Conclusion:LR with subsequent metastasis is a rare event. LR appears to be best viewed as a marker of tumor aggressiveness rather than the cause of metastasis and poor survival. LR in bone sarcoma patients should warn providers of a high risk of imminent metastasis.

Background and Objectives: Nonpulmonary metastases (NPM) are rare, associated with a poorer prognosis, and maybe missed on conventional chest imaging for sarcoma surveillance. We determined (1) the proportion of NPM occurring in isolation or with synchronous or prior pulmonary metastases (PM), and (2) if initial NPM would have been recognized with a standard surveillance protocol.Methods: Investigators identified patients who developed initial NPM without prior evidence of or concurrent PM from an ongoing cohort of bone and soft tissue sarcoma (STS) patients. Logistic regression at univariate level was done.Results: There were 138/630 (22%) patients with metastasis and 66 (10%) had NPM: 50 (8%) patients had PM presenting first, while 16 (3%) had initial NPM.Malignant peripheral nerve sheath tumor, angiosarcoma, rhabdomyosarcoma, synovial sarcoma, and myxoid liposarcoma were six times more likely to develop initial NPM than other subtypes of STS with odds ratio = 6 (95% confidence interval:1.93-18.65, p value < 0.01). Chest imaging and physical examination were sufficient to identify NPM in all except three bone sarcoma patients.Conclusions: Patients who develop initial NPM are rare and demonstrate a predilection towards some subtypes of extremity sarcoma. They develop oligometastatic disease, which may be amenable for surgical excision. All isolated or initial NPM in STS patients were discovered by physical examination and standard chest imaging.