Comparison of Surgical Outcomes Between a Triplane Proximal Femoral Osteotomy and the Modified Dunn Procedure for Stable, Moderate to Severe Slipped Capital Femoral Epiphysis

Sikora‐Klak, Jakub; Bomar, James D.; Paik, Christina; Wenger, Dennis R.; Upasani, Vidyadhar V.

doi:10.1097/bpo.0000000000000968

Cited by 29 publications

(32 citation statements)

References 35 publications

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“…2017 , Sikora-Klak et al. 2017 ), confirming that D is technically demanding. Conversely, in a previous report, we excluded a substantial impact of surgeon’s volume and experience in Imhauser ITOs, as 16 different surgeons performed 53 procedures across the years (Trisolino et al.…”

Section: Discussionmentioning

confidence: 92%

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Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis

et al. 2018

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Background and purposeThe best treatment option for severe slipped capital femoral epiphysis (SCFE) is still controversial. We compared clinical and radiographic outcomes of modified Dunn procedure (D) and in situ fixation (S) in severe SCFE.Patients and methodsWe retrospectively compared D and S, used for severe stable SCFE (posterior sloping angle (PSA) > 50°) in 29 patients (15 D; 14 S). Propensity analysis and inverse probability of treatment weights (IPTW) to adjust for baseline differences were performed. Patients were followed for 2–7 years.ResultsAvascular necrosis (AVN) occurred in 3 patients out of 15, after D, causing conversion to total hip replacement (THR) in 2 cases. In S, 1 hip developed chondrolysis, requiring THR 3 years after surgery. 3 symptomatic femoroacetabular impingements (FAI) occurred after S, requiring corrective osteotomy in 1 hip, and osteochondroplasty in another case. The risk of early re-operation was similar between the groups. The slippage was corrected more accurately and reliably by D. The Nonarthritic Hip Score was similar between groups, after adjusting for preoperative and postoperative variables.InterpretationAlthough D was superior to S in restoring the proximal femoral anatomy, without increasing the risk of early re-operation, some concern remains regarding the potential risk of AVN in group D.

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Section: Discussionmentioning

confidence: 92%

“…Recently Sikora-Klak et al. ( 2017 ) retrospectively compared 14 D and 12 Imhauser ITO, performed for high-grade stable SCFE. They found 3/14 AVN in the D group, but no difference in the rate of complications and a slightly higher rate of re-operations following ITOs.…”

Section: Discussionmentioning

confidence: 99%

Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis

et al. 2018

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“…The discussion regarding prophylactic fixation of a contralateral, asymptomatic, normal hip in patients with SCFE arose in view of the high rates of bilateral or sequential slips. The prophylactic approach confers a theoretical advantage of reducing the risk of osteoarthritis and deformity, particularly in delayed diagnosis where there is a higher possibility of slips being moderate to severe in nature 2627)…”

Section: Discussionmentioning

confidence: 99%

Alpha Angle as a Predictor of Impending Contralateral Slipped Capital Femoral Epiphysis in an Asian Population

et al. 2019

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BackgroundProphylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial. The alpha angle, a measurement of femoral head-neck aspherity, was proposed as a predictor of progression of contralateral SCFE with a treatment threshold of greater than 50.5°. The aim of this study was to evaluate its validity in our cohort of patients.MethodsA retrospective review of a 10-year series of patients who presented with unilateral SCFE was conducted. Minimum follow-up duration to identify contralateral progression was 18 months. Age, sex, ethnicity, and endocrinopathies were noted. Alpha angle measurements of the unaffected hip were performed by two independent observers. The average values of measurements were used for analysis. Univariate and multivariate logistic regression analyses were performed to identify predictors of contralateral progression. A receiver operating characteristic (ROC) curve was generated.ResultsThere were 43 patients with unilateral SCFE. Seven patients (16.3%) developed contralateral SCFE. There were 31 males (72.1%) and 12 females (27.9%). The mean duration from index surgery to contralateral fixation was 43.9 weeks (range, 16.2 to 77 weeks). The mean alpha angle was significantly higher in the patients with contralateral progression (mean, 50.7°; standard deviation [SD], 5.4°; range, 43.8° to 58.5°) than in the patients without progression (mean, 43.0°; SD, 4.2°; range, 33.0° to 52.5°; p < 0.001). The alpha angle was also identified as a statistically significant predictor of contralateral progression on multivariate analysis (p = 0.02). The intraclass correlation coefficient for interobserver reliability was moderately strong at 0.76 (95% confidence interval, 0.55 to 0.87). The area under the ROC curve was 0.88. The treatment threshold of 50.5° had a sensitivity of 0.43, specificity of 0.94, and number needed to treat (NNT) of 2.7. The ideal treatment threshold derived from the ROC curve was 49.0°, which had a sensitivity of 0.71, specificity of 0.89, and an NNT of 1.7.ConclusionsAlpha angle is a potential predictor of contralateral hip involvement in children with SCFE who may benefit from prophylactic hip fixation. Results from our series suggest a treatment threshold be 49.0°. However, given the limited sample size and moderately strong interobserver reliability, larger studies are needed to validate our findings.

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“…Alpha angle has been measured on the radial reconstruction of the MRI scans according to the sagittal view in cases of suboptimal X-rays. The mean medial proximal femoral angle 17 , the posterior wall sign (PWS) and the ischial spine sign (ISS) were also evaluated 18 . The acetabular retroversion index (ARI) was quantified as described previously 19,20 .…”

Section: Radiographic Analysismentioning

confidence: 99%

Midterm Follow-Up and Assessment of Cartilage Thickness by Arthro-Magnetic Resonance Imaging After Arthroscopic Cam Resection, Labral Repair, and Rim Trimming Without Labral Detachment

Forster-Horváth

Unterreithmeier

Fries

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Comparison of Surgical Outcomes Between a Triplane Proximal Femoral Osteotomy and the Modified Dunn Procedure for Stable, Moderate to Severe Slipped Capital Femoral Epiphysis

Abstract: Level III-retrospective comparative study.

Cited by 29 publications

References 35 publications

Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis

Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis

Alpha Angle as a Predictor of Impending Contralateral Slipped Capital Femoral Epiphysis in an Asian Population

Midterm Follow-Up and Assessment of Cartilage Thickness by Arthro-Magnetic Resonance Imaging After Arthroscopic Cam Resection, Labral Repair, and Rim Trimming Without Labral Detachment

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