Intraoperative Monitoring of Epiphyseal Perfusion in Slipped Capital Femoral Epiphysis

Abstract

Video 1 Surgical technique for intraoperative assessment of epiphyseal perfusion using an ICP probe in a 12-year-old patient with an unstable SCFE.

Intraoperative assessment of femoral head perfusion during surgical hip dislocation for slipped capital femoral epiphysis

“…These results are similar to previous studies that show those with no perfusion intraoperative are at high risk of developing AVN [ 15 , 16 , 20 ] and those who do have perfusion intraoperatively are at low risk of developing AVN [ 18 , 19 ]. In comparison to other techniques which have used laser Doppler flowmetry or ICP monitoring, our paper describes a novel, inexpensive, readily available and reliable way to assess intraoperative perfusion using an arterial line.…”

“…Eight cases also needed to be excluded due to no documentation of intraoperative arterial monitoring or probe issues that did not enable an assessment to be made. This reduced the total numbers in our study, however, the numbers in our study are comparable with the numbers in previous studies that have assessed intraoperative femoral head perfusion and its correlation with post-operative AVN [ 14 , 19 ].…”

“…The intraoperative assessment of femoral head perfusion is becoming increasingly common when treating SCFEs [ 31 , 32 ]. Many studies have now published results suggesting that this may be a more accurate and easier way to predict the development of AVN rather than previously described methods such as MRI, bone scan or angiography [ 14 , 19 ]. It also has the benefit of real-time adjustment of ostectomy and reduction position to ensure adequate head perfusion is maintained.…”

“…The methods of assessing femoral head perfusion that have been described are evaluation of bleeding by creating a drill hole [ 16 , 29 , 33 ], the use of Laser Doppler Flowmetry [ 17 , 20 ] and intracranial pressure monitoring (ICP) [ 14 , 19 ]. Assessing bleeding via a drill hole is a simple way to assess femoral head perfusion but can only be done with open surgeries.…”

“…Six out of their 26 patients had no measurable flow, but all regained flow following a percutaneous capsular decompression. None of these patients developed post-operative AVN [ 19 ].…”