Predicting subsequent contralateral slipped capital femoral epiphysis: An evidence-based approach

Abstract

Purpose The purpose of this study was to identify risk factors for developing a subsequent contralateral slipped capital femoral epiphysis (SCFE) and provide a prediction score to quantify risk of subsequent slip at the time of initial presentation. Methods This retrospective study included patients that presented with a unilateral SCFE between 2006 and 2017. Chart and radiographic review were performed to collect demographic, clinical and radiographic risk factors. Descriptive statistics, univariate analyses and multivariate regression analysis were used to compare risk factors between patients that did or did not develop a subsequent contralateral SCFE. Results This study included 183 patients and 33 patients (18%) developed a subsequent contralateral SCFE. Younger age at time of initial presentation, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between both sides during index presentation were significant predictors of subsequent contralateral SCFE. Specifically, age ≤ 11 years, modified Oxford Score ≤ 20 and difference in epiphyseal-diaphyseal angle of ≤ 21° between both hips were predictive of a contralateral slip (Area Under the Curve = 0.78; p < 0.05). The presence of each risk factor increased the risk of subsequent contralateral SCFE and having all three risk factors increased the risk to 73%. Conclusion There is a significant risk of subsequent contralateral SCFE in patients with unilateral SCFE, and predictive risk factors include younger age, lower modified Oxford Score and smaller difference in epiphyseal-diaphyseal angle between the affected and unaffected hips. Level of Evidence Level III

The contralateral hip in slipped capital femoral epiphysis: Is there an easy-to-use algorithm to support a decision for prophylactic fixation?

“…8 Younger age and minor differences in the epiphyseal–diaphyseal angle between both hips were predictors of contralateral slip in a recent study. 23 Our results show that age is an essential factor to consider when deciding upon a prophylactic fixation to be offered to a child with unilateral SCFE. However, our results do not support using the epiphyseal–diaphyseal angle in a decision algorithm for prophylactic fixation.…”

“…25 Triradiate cartilage assessment for skeletal maturity as a predictor for a subsequent slip in the second hip has been advocated. 11 , 23 , 25 , 26 However, Danino et al 27 showed that triradiate status and Risser’s grade did not influence their final multivariate analysis strength, but so did epiphyseal extension ratio, posterior epiphyseal angle and posterior sloping angle. When evaluating radiographs, the experience and the variation between clinicians must be considered.…”

Role of the prophylactic fixation of contralateral unaffected hip in paediatric unilateral slipped capital femoral epiphysis: a systematic review

“…Furthermore, its incidence appears to be slightly increasing in many world regions, likely due to changes in childhood obesity prevalence ( 3 ). Indeed, several risk factors have been identified, including obesity, ethnicity, modified Oxford bone age score, renal failure, endocrinopathies but, above all, hypothyroidism and growth hormone deficiency ( 4 , 5 , 6 , 7 , 8 ).…”

“…• The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.endocrinopathies but, above all, hypothyroidism and growth hormone deficiency (4,5,6,7,8). The prevalence of bilateral SCFE is highly variable and ranges between 20 and 80% (9, 10); in approximately 50% of cases, a simultaneous bilateral slip occur (11).…”

“…endocrinopathies but, above all, hypothyroidism and growth hormone deficiency (4,5,6,7,8). The prevalence of bilateral SCFE is highly variable and ranges between 20 and 80% (9, 10); in approximately 50% of cases, a simultaneous bilateral slip occur (11).…”