Clinical Implications of Anatomical Wear Characteristics in Slipped Capital Femoral Epiphysis and Primary Osteoarthritis

Abraham, Edward; Gonzalez, Mark H.; Pratap, Surya; Amirouche, Farid; Atluri, Prasant; Simon, P.

doi:10.1097/bpo.0b013e3181558c94

Cited by 86 publications

(65 citation statements)

References 44 publications

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“…Overall the strategy was to select random samples with respect to femoral head location although each sample was cut to include tissue from at least two quadrants of the head. The femoral head is often defined into four quadrants: anterior, posterior, inferior and superior [39,40]. It is important to note that samples were obtained from trabecular bone only, and did not include cortical bone.…”

Section: Sample Preparationmentioning

confidence: 99%

Towards new material biomarkers for fracture risk

Greenwood

Clement

Dicken

et al. 2016

Bone

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Osteoporosis is a prevalent bone condition, characterised by low bone mass and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density (BMD) using dual energy X-ray absorption (DEXA). However, the risk of osteoporotic fracture is determined collectively by bone mass, architecture and physicochemistry of the mineral composite building blocks. Thus DEXA scans alone inevitably fail to fully discriminate individuals who will suffer a fragility fracture. This study examines trabecular bone at both ultrastructure and microarchitectural levels to provide a detailed material view of bone, and therefore provides a more comprehensive explanation of osteoporotic fracture risk. Physicochemical characterisation obtained through X-ray diffraction and infrared analysis indicated significant differences in apatite crystal chemistry and nanostructure between fracture and non-fracture groups.Further, this study, through considering the potential correlations between the chemical biomarkers and microarchitectural properties of trabecular bone, has investigated the relationship between bone mechanical properties (e.g. fragility) and physicochemical material features.

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Section: Sample Preparationmentioning

confidence: 99%

Towards new material biomarkers for fracture risk

Greenwood

Clement

Dicken

et al. 2016

Bone

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“…Abraham et al [29] have emphasized this concept. The timing of proximal femoral osteotomies in the treatment of SCFE remains controversial and depends on the acuity and severity of the slip.…”

Section: Femoral Osteotomiesmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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“…Although residual SCFE deformity may partially remodel after in situ pinning [29], the remodeling process leads to femoroacetabular impingement (FAI), an abnormal contact between the proximal femur and the anterior acetabular rim [30]. FAI secondary to SCFE has been reported to lead to articular cartilage damage [1,21,22,32], which is related to the development of osteoarthritis [14].…”

Section: Introductionmentioning

confidence: 99%

Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE

Novais

Hill

Carry

et al. 2015

Clinical Orthopaedics &Amp; Related Research

100

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Background In situ pinning is the conventional treatment for a stable slipped capital femoral epiphysis (SCFE). However, with a severe stable SCFE the residual deformity may lead to femoroacetabular impingement and articular cartilage damage. A modified Dunn subcapital realignment procedure has been developed to allow for correction at the level of the deformity while preserving the blood supply to the femoral head. Questions/purposes We compared children with severe stable SCFE treated with the modified Dunn procedure or in situ pinning in terms of (1) proximal femoral radiographic deformity; (2) Heyman and Herndon clinical outcome; (3) complication rate; and (4) number of reoperations performed after the initial procedure. Methods In this nonmatched retrospective study, 15 patients treated with the modified Dunn procedure (between 2007 and 2012) and 15 treated with in situ pinning (between 2001 and 2009) for severe but stable SCFE were followed for a mean of 2.5 years (range, 1-6 years). During the period in question, the decision regarding which procedure to use was based on the on-call surgeon's discretion; six surgeons performed in situ pinning and three surgeons performed the modified Dunn procedure. A total of 15 other patients were treated for the same diagnosis during the study period but were lost to followup before 1 year; of those, 12 were in the in situ pinning group. Radiographs were reviewed to measure the AP and lateral alpha angles, femoral head-neck offset, and Southwick angle preoperatively and at the latest clinical visit. The Heyman and Herndon clinical outcome, complications, and subsequent hip surgeries were recorded. Results At latest followup, the median AP alpha angle (52°, range 41°-59°versus 76°, interquartile range [IQR]: 68°-

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Clinical Implications of Anatomical Wear Characteristics in Slipped Capital Femoral Epiphysis and Primary Osteoarthritis

Abstract: Prognostic study.

Cited by 86 publications

References 44 publications

Towards new material biomarkers for fracture risk

Towards new material biomarkers for fracture risk

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE

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