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

Abstract

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.

Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

“…These 2 hips might otherwise have developed osteonecrosis secondary to inadequate capsular decompression, yielding a potential osteonecrosis rate of 15.4%. This potential rate compares well with the 16.2% rate of osteonecrosis found in a recent meta-analysis of unstable SCFE 22 . We believe that demonstrating femoral head perfusion before and after a capsular decompression is paramount in the prevention of osteonecrosis.…”

Strategies to Avoid Osteonecrosis in Unstable Slipped Capital Femoral Epiphysis

“…The role for capsular decompression in the unstable slip was evaluated in a 2015 meta-analysis by Ibrahim et al 44 . That review included 9 Level-III or IV studies 4,9,16,[22][23][24][25]35,45 published from 1997 to 2012.…”

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

“…Osteonecrosis is the most severe complication after unstable SCFE treatment. Although previous studies [10,16,17,19,20,23,[27][28][29] vary widely in terms of the proportion of patients who develop osteonecrosis after unstable SCFE, a recent systematic review of the literature reported an overall rate of 24% [29]. Osteonecrosis leads to femoral head collapse and further hip osteoarthritis, and it is the most common indication for hip arthroplasty in patients with SCFE [11,12].…”