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Gordon, Joel; Abrahams, Matthew S.; Dobbs, Matthew B.; Luhmann, Scott J.; Schoenecker, Perry L.

doi:10.1097/00004694-200205000-00017

Cited by 20 publications

(4 citation statements)

References 36 publications

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“…The definition of osteonecrosis was similar in all nine studies, utilizing radiographs for evidence of sclerosis and/or collapse. Some of the studies also utilized bone scans to demonstrate a lack of blood supply to the femoral head [ 15 , 17 , 18 ]. The follow-up period of the studies varied, but the shortest follow-up period was 24 months from the date of treatment to record the appearance of osteonecrosis [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Peterson et al [ 21 ] suggested that acute displacement of the femoral epiphysis compromises the blood flow which may be restored by a timely reduction for the unstable SCFE. Both Petersen et al [ 21 ] and Gordon et al [ 18 ] reported lower rates of osteonecrosis in patients treated within 24 h compared to those treated after 24 h. Thus, emergent treatment and hip decompression either with capsulotomy or aspiration is currently recommended in all unstable SCFE to optimize blood flow to the femoral head [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Hip decompression of unstable slipped capital femoral epiphysis: A systematic review and meta-analysis

Ibrahim

Mahmoud

Riaz

et al. 2015

Journal of Children's Orthopaedics

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PurposeSlipped capital femoral epiphysis (SCFE) is one of the most common adolescent hip conditions. Unstable SCFE is characterized by sudden and severe hip pain with the inability to weight bear, even with crutches. Osteonecrosis of the femoral head is increased in patients with unstable SCFE. The aim of our study was to systematically review the literature that compares hip decompression to no hip decompression of unstable SCFE.MethodsWe searched several databases from 1946 to 2014 for any observational or experimental studies that evaluated hip decompression and osteonecrosis of unstable SCFE. We performed a meta-analysis using a random effects model to pool odds ratios (ORs) for the comparison of osteonecrosis between patients undergoing hip decompression and no hip decompression. We also investigated the type of hip decompression performed. Descriptive, quantitative, and qualitative data were extracted.ResultsOf the 17 articles identified, nine studies (eight case series and one retrospective cohort study) were eligible for the meta-analysis, with a total of 302 unstable SCFE. The pooled OR = 0.91 of osteonecrosis between hip decompression and no hip decompression was in favor of hip decompression, but was not statistically significant [95 % confidence interval (CI): 0.47, 1.75; p = 0.54, I2 = 0 %]. No significant differences in the rates of osteonecrosis were detected in unstable SCFE with open and percutaneous hip decompression alone (OR = 0.97, 95 % CI: 0.36, 2.62; p = 0.69, I2 = 19.1 %) or hip decompression with bony procedures (OR = 0.99, 95 % CI: 0.35, 2.79; p = 0.69, I2 = 0 %).ConclusionsThe cumulative evidence at present does not indicate an association between hip decompression and a lower rate of osteonecrosis of unstable SCFE. However, hip decompression of unstable SCFE remains an option that can potentially decompress the intracapsular hip pressure and optimize the blood flow to the femoral head. Thus, multicenter prospective cohort studies are required and will be able to answer this question with more certainty and a higher level of evidence.Level of evidenceLevel III/IV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hip decompression of unstable slipped capital femoral epiphysis: A systematic review and meta-analysis

Ibrahim

Mahmoud

Riaz

et al. 2015

Journal of Children's Orthopaedics

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“…The treatment of unstable SCFE is more controversial and many techniques have been described. These include in situ pinning [ 10 ], reduction with decompression arthrotomy and pinning [ 11 ], open reduction and pinning [ 12 ] and sub-capital realignment using the modified Dunn procedure [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative assessment of femoral head perfusion during surgical hip dislocation for slipped capital femoral epiphysis

Michalopoulos

Spelman

Balakumar

et al. 2021

Journal of Hip Preservation Surgery

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Avascular necrosis is the most devastating complication of slipped capital femoral epiphysis, leading to collapse of the femoral head, increased risk of osteoarthritis and the requirement of early total hip arthroplasty. It is believed that intraoperative femoral head perfusion assessment may be an accurate predictor of post-operative avascular necrosis (radiographic collapse). At our institution, femoral head perfusion is assessed intraoperatively during all sub-capital realignment procedures. We hypothesize that our method is accurate in predicting the risk of developing post-operative avascular necrosis. In this retrospective study, we collected data from all patients that had intraoperative blood flow measurements during sub-capital realignment procedures. We correlated this with long-term radiographs looking for radiographic collapse. The intraoperative femoral head perfusion assessments during sub-capital realignment procedures for slipped capital femoral epiphysis at our institution, between January 2015 and March 2020 inclusive were assessed for reliability. In total, 26 of 35 patients had intraoperative femoral head perfusion present. Only 2 (8%) of these patients developed radiographic collapse. In contrast, 7 (78%) of the 9 patients who did not have femoral head perfusion present intraoperatively developed radiographic collapse, indicating that our method may be reliable in predicting a patient’s post-operative risk of developing avascular necrosis.

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“…[8,9] Several investigators have recommended an urgent (before 24 hours) surgical reduction to relieve the pressure and allow reperfusion of the femoral head. [10] Others recommend that definitive stabilization should be delayed for at least 7 days to allow the inflammation and synovitis to settle. [11,12] Vegter [13] proposed that increased intra-articular pressure of the hip associated with excess joint fluid should be treated by traction in a flexed position until the effusion settles.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous pinning after prolonged skeletal traction with the hip in a flexed position for unstable slipped capital femoral epiphysis

Matsushita

Mishima

Iwata³

et al. 2017

Medicine

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Background:Unstable slipped capital femoral epiphysis (SCFE) has a relatively high risk of avascular necrosis of the femoral head. Standard treatment for unstable SCFE is still controversial. We reviewed unstable SCFE case series treated with the standardized protocol, which consisted of percutaneous pinning after prolonged skeletal traction.Methods:Our treatment regimen for unstable SCFE patients included 1 week or more of skeletal traction with the hip in a flexed position of 45 degrees, and subsequent percutaneous pinning after unintentional reduction. Eleven patients were treated in our institution and an affiliated hospital between 2003 and 2013. Sex, age at surgery, body mass index, the presence of hormonal abnormality, duration between onset and surgery, head shaft angle, posterior tilting angle, and modified Harris hip score were investigated from the medical records and radiographs.Results:There were 8 male and 3 female with an average age of 11.7 years and an average body mass index of 24.5 kg/mm2. No patients had hormonal abnormalities. The duration between onset and surgery ranged from 8 to 16 days. The average preoperative and postoperative head shaft angles were 126 and 141 degrees, respectively. Postoperative posterior tilting angle was averaged of 30.7 degrees, which decreased to 21.5 degrees during follow-up period. One patient showed mild avascular necrosis only confirmed by magnetic resonance imaging, but he was uneventfully treated without additional procedures. As a result, all patients had a perfect modified Harris hip score of 91 points.Conclusions:Prolonged traction with the hip in a flexed position may not only provide gradual reduction of posteriorly displaced epiphysis but also decrease intra-articular pressure before surgery. Although percutaneous pinning after unintentional reduction leaves mild displacement of the femoral epiphysis, remodeling could be expected during remaining growth period.

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Untitled

Cited by 20 publications

References 36 publications

Hip decompression of unstable slipped capital femoral epiphysis: A systematic review and meta-analysis

Hip decompression of unstable slipped capital femoral epiphysis: A systematic review and meta-analysis

Intraoperative assessment of femoral head perfusion during surgical hip dislocation for slipped capital femoral epiphysis

Percutaneous pinning after prolonged skeletal traction with the hip in a flexed position for unstable slipped capital femoral epiphysis

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