Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach

Abstract

Purpose Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence IV

Simultaneous Morscher’s osteotomy and arthroscopic debridement in the management of Legg–Calvé–Perthes disease: a case report and literature review

“…Results from that study, however, did not recommend combining these two procedures for cases of severe deformity and patients younger than 28-years-old [ 13 ]. Baraka et al [ 14 ] performed a combined Imhauser osteotomy with osteochondroplasty through the surgical hip dislocation approach on adolescent patients with moderate and severe stable slipped capital epiphysis. This involved surgical dislocation and osteochondroplasty followed by an intertrochanteric osteotomy and trochanteric transfer [ 14 ].…”

“…Baraka et al [ 14 ] performed a combined Imhauser osteotomy with osteochondroplasty through the surgical hip dislocation approach on adolescent patients with moderate and severe stable slipped capital epiphysis. This involved surgical dislocation and osteochondroplasty followed by an intertrochanteric osteotomy and trochanteric transfer [ 14 ]. The mean preoperative HHS improved from 65.39 to 93.3 (27.91 points difference); the mean lower limb length discrepancy improved from 1.99 cm to 0.27 cm (1.72 cm) [ 14 ].…”

“…This involved surgical dislocation and osteochondroplasty followed by an intertrochanteric osteotomy and trochanteric transfer [ 14 ]. The mean preoperative HHS improved from 65.39 to 93.3 (27.91 points difference); the mean lower limb length discrepancy improved from 1.99 cm to 0.27 cm (1.72 cm) [ 14 ]. More recently, Faure et al .…”

Surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz: a systematic review

“…Some recent papers suggested to improve Imhauser osteotomy by performing a neck osteochondroplasty through a surgical dislocation approach. They considered this procedure safe and effective in 62 hips with severe stable SCFE after a mean follow-up of 4.1 years [43][44][45]. However, in a previous 24 years long term follow-up study in which SCFE were treated by Imhauser osteotomy, the incidence of osteoarthritis was high (45%) [46].…”

Morscher’s femoral neck lengthening osteotomy through surgical hip dislocation approach for preservation of Perthes and Perthes-like deformities

“…With improved understanding of the blood supply to the FH, and the ability to safely dislocate the hip, 20 surgical hip dislocation (SHD) approach has been recently utilized in treatment for symptomatic residual deformities in adolescent hips. 2,12,13,18,21,22 It permits assessment and treatment of intra-articular FAI and related chondro-labral pathology, reshaping the head-neck contour through osteochondroplasty, as well as biomechanical restoration of the hip with various extra-articular procedures. 11,23 However, the outcomes of surgical dislocation approach combined simultaneously with true femoral neck lengthening osteotomy are not well established.…”