Long-Term Follow-Up of Slipped Capital Femoral Epiphysis

Carney, Brian T.; Weinstein, Stuart L.; Noble, Jeffery S.

doi:10.1097/01241398-199111000-00043

Cited by 54 publications

(104 citation statements)

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“…AVN is recognized as a risk factor for early development of severe osteoarthritis of the hip [6,37,39]. In the past, two classic studies defined the role of in situ fixation in the treatment of SCFE as a safe and reliable method [10,11]. The Iowa hip rating score after in situ fixation of moderate and severe chronic SCFE was reportedly 85 out of a possible 100 points at an average of 41 years of followup [11].…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

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Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

Clinical Orthopaedics &Amp; Related Research

133

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Background Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term. Questions/Purposes We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment. Methods A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively. Where Are We Now? A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE. Where Do We Need to Go? Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes. How Do We Get There? Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.

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Section: Search Strategies and Criteriamentioning

confidence: 99%

“…The natural history is largely dependent on both the degree of deformity [11] and the occurrence of complications of treatment, mainly avascular necrosis of the femoral head (AVN) and chondrolysis [37,39,50,53]. Most long-term studies demonstrate some loss of function over time with all degrees of deformity [16,31,62,74,78].…”

Section: Introductionmentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

Clinical Orthopaedics &Amp; Related Research

133

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“…Traditionally, in situ pinning of a clinically stable SCFE has been the most widely accepted method of treatment and is associated with an acceptable prognosis [14][15][16]. However, controversy exists regarding the treatment of moderate/severe degree of slips, particularly as relates to residual deformity.…”

Section: Introductionmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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“…Greater displacement in patients with SCFE predicts the development of osteoarthritis [9,10,15,50]. Therefore, to prevent further slip progression, surgical fixation of the epiphysis is the recommended primary treatment [2,4,16,34,38,51].…”

Section: Introductionmentioning

confidence: 99%

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) -so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations. Questions/purposes We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/ unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? Methods We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability. Results Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively. Conclusion Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE.

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Long-Term Follow-Up of Slipped Capital Femoral Epiphysis

Cited by 54 publications

References 0 publications

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

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