Hip arthroscopy following slipped capital femoral epiphysis fixation: Chondral damage and labral tears findings

Abstract

Purpose This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). Methods This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. Results We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8–20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. Conclusion A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. Level of evidence IV

Do Osteochondroplasty Alone, Intertrochanteric Derotation Osteotomy, and Flexion-Derotation Osteotomy Improve Hip Flexion and Internal Rotation to Normal Range in Hips With Severe SCFE? - A 3D-CT Simulation Study

“…Patients with severe SCFE deformity with obligatory external rotation in flexion benefit from a flexion-derotation osteotomy to improve the range of impingement-free motion. Besomi et al 14 reported on the results of hip arthroscopy treatment, including osteochondroplasty in 17 patients with residual SCFE deformity, and found only 6 degrees of hip flexion and 14 degrees of IR improvement. Balakumar et al 37 reported a less significant improvement of hip IR for patients with severe and moderate SCFE deformity treated with arthroscopic osteochondroplasty (mean improvement 20 degrees, range 0 to 20 degrees) compared with open femoral neck osteotomy (mean improvement 50 degrees, range 30 to 70 degrees).…”

“…12 Hip arthroscopy is the mainstay of surgical treatment of cam-type FAI, and the role of arthroscopic cam resection of the femoral head-neck junction has been expanded to the treatment of symptomatic residual deformity associated with SCFE. [13][14][15][16] However, arthroscopic treatment may be limited to restoring the normal range of motion in hips with severe SCFE. 17 Several femoral osteotomies have been described to improve the alignment of the proximal femur in hips with residual deformity due to severe SCFE, including the Imhauser flexion-derotational intertrochanteric osteotomy, 18 the Southwick triplane proximal osteotomy, 3 an osteotomy at the base of the femoral neck, 19,20 the femoral neck closing wedge osteotomy according to Dunn 21 and Fish, 22 a simple diaphyseal derotation osteotomy with intramedullary fixation.…”

“…Hip arthroscopy is the mainstay of surgical treatment of cam-type FAI, and the role of arthroscopic cam resection of the femoral head-neck junction has been expanded to the treatment of symptomatic residual deformity associated with SCFE 13–16. However, arthroscopic treatment may be limited to restoring the normal range of motion in hips with severe SCFE 17.…”

Limited Hip Flexion and Internal Rotation Resulting From Early Hip Impingement Conflict on Anterior Metaphysis of Patients With Untreated Severe SCFE Using 3D Modelling

“…34 Anterior cartilage lesions are comparable with the found impingement location in the current study. Another recent study 35 evaluated patients with sequelae of SCFE undergoing hip arthroscopy at mean 2 years after initial surgery and reported labrum tears and acetabular chondral damage in the majority of patients. Hip arthroscopy is increasingly being used for treatment of FAI.…”