Is prophylactic fixation preferable to active surveillance of the unaffected contralateral hip in unilateral slipped capital femoral epiphysis?- A Systematic Review

Shetty, Vijith; Akhtar, Kash

doi:10.37515/ortho.8231.4105

Cited by 1 publication

(2 citation statements)

References 41 publications

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“…A systematic review by Shetty et al also described an increased risk for the contralateral side in patients younger than 10 to 12.4 years. 14 Lindell et al even advocated prophylactic SCFE pinning in children under 13 years in their easyto-use algorithm for contralateral slipping risk. 15 Therefore, despite age being a frequently described risk factor in the literature, it appears that surgeons do not uniformly use this variable in practice.…”

Section: Discussionmentioning

confidence: 99%

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Surgeon Preference for Prophylactic Contralateral Fixation in Slipped Capital Femoral Epiphysis (SCFE) Patients: A Nationwide POSNA Survey Study

Donnelly

Layne

Castañeda

2023

Journal of Pediatric Orthopaedics

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Background: It is estimated that 11% to 60% of unilateral slipped capital femoral epiphysis (SCFE) patients will develop contralateral pathology, usually within 18 months after the first event. Despite this, prophylactic fixation remains controversial, and there is significant variability in surgeon preferences. Thus, this study aimed to determine which factors predict surgeon preferences for prophylactic contralateral pinning in SCFE patients. Methods: We designed a survey for pediatric orthopedic surgeons to collect data on (1) surgeon and hospital characteristics, (2) individual preference for contralateral SCFE pinning in three disparate hypothetical scenarios, and (3) personal risk-aversion traits. The questionnaire was distributed across the United States by the POSNA Evidence-Based Orthopaedics Committee. All POSNA members were eligible to respond. We performed analyses to evaluate the role of patient risk factors in hypothetical surgical decision-making and to determine if surgical training, hospital characteristics, and geographic region influenced prophylactic pinning in a surgeon’s real-life practice. Results: A total of 126 POSNA members responded to the survey. In the last year, a median of 6.5 SCFE patients was seen per surgeon (1243 patients total). A median of 10% of those patients underwent prophylactic contralateral fixation. In multiple analyses, surgeons were influenced by body mass index, open triradiate cartilage, patient race, various endocrine abnormalities, and specific radiographic measurements when deciding to fix the contralateral side prophylactically. Moreover, in multivariate regression, more years in practice and a hospital size of 500+ beds predicted fewer prophylactic fixation procedures (all P<0.05). Surgeons practicing in the South Atlantic, New England, and Mountain regions of the United States estimated the highest rate of contralateral pinning. Conclusions: This study’s findings suggest that multiple factors influence surgeons’ decisions to prophylactically fix the contralateral side in SCFE patients. Surgical training, hospital characteristics, and geographical regions played a role in decision-making. Level of Evidence: N/A

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Section: Discussionmentioning

confidence: 99%

“…. A systematic review by Shetty et al also described an increased risk for the contralateral side in patients younger than 10 to 12.4 years 14 . Lindell et al even advocated prophylactic SCFE pinning in children under 13 years in their easy-to-use algorithm for contralateral slipping risk 15 .…”

Section: Discussionmentioning

confidence: 99%