Relationships Between Severity of Deformity and Impingement in Slipped Capital Femoral Epiphysis

Jones, Carly E.; Cooper, Anthony; Doucette, J. Ronald; Buchan, Lawrence L.; Wilson, David R.; Mulpuri, Kishore; d’Entremont, Agnes G.

doi:10.1097/bpo.0000000000000641

Cited by 12 publications

(10 citation statements)

References 23 publications

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“…Although the exact etiology has not been determined, the correlation has been found with obesity, race, and, more so in atypical presentations, endocrine disorders . The resultant deformity in SCFE has been shown to be associated with premature hip osteoarthritis, hip pain, decreased range of motion, impingement, and long‐term disability, and increasing severity of deformity increases the risk of abnormal femoroacetabular mechanics . For this reason, it is crucial to classify SCFE severity accurately and use this information to guide treatment, which commonly consists of in situ pinning, reduction, osteoplasty, or a variety of proximal femoral realignment osteotomies …”

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confidence: 99%

Evaluation of the Three‐Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis

Bland

Valdovino

Jeffords

et al. 2019

Journal Orthopaedic Research

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The purpose of this study was to quantify three-dimensional translational and angular deformity (defined as theta) present at the proximal femoral physis in slipped capital femoral epiphysis (SCFE), and to use theta to differentiate between SCFE hips, contralateral unaffected hips, and normal hips by comparing to the current gold standard measure of the Southwick slip angle (SSA). 3DCT reconstructions of the pelvis and femur in SCFE patients and normal adolescents were obtained and pelvic position was standardized. The center point and direction vector of the femoral epiphysis was determined. The femoral neck axis was defined. The angle between the femoral neck axis and epiphysis vector defined the 3D angle of deformity (theta). The 3D translation of the femoral epiphysis, measured as a percentage of femoral neck diameter, was measured in three planes. The average theta angle was significantly greater in SCFE hips (46.5 ± 24.3°) compared with control (13.7 ± 6.4°) or normal (11.7 ± 3.7°) hips (p < 0.001). There was no significant difference in theta angle between control and normal hips (p = 0.468). Theta angle correlated strongly with SSA (r s = 0.737, p < 0.001). Statement of clinical significance: The proximal femoral deformity in patients with slipped capital femoral epiphysis can be defined by measuring displacement of the epiphysis in all three dimensions in relation to the femoral neck axis. This information can be used in epiphyseal reorientation surgery to ensure anatomic reduction. The similarity between control and normal hips may argue against the thought that there is pre-existing deformity in a pre-slip condition of unaffected contralateral hips in SCFE patients.

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confidence: 99%

Evaluation of the Three‐Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis

Bland

Valdovino

Jeffords

et al. 2019

Journal Orthopaedic Research

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“…39 Even in mild slips, cam-type FAI related to SCFE has been observed in 3D geometric models. 13,40 Intraarticular chondral and labral damage has been reported even in mild slips in 50% to 100% of SCFE cases treated with arthroscopic femoral osteochondroplasty [25][26][27][28][29] (Table 3). Notably, in these five studies, there was less intraarticular damage when hip arthroscopy was performed earlier.…”

Section: Discussionmentioning

confidence: 99%

Hip arthroscopy following slipped capital femoral epiphysis fixation: Chondral damage and labral tears findings

Besomi

Escobar

Álvarez

et al. 2021

Journal of Children's Orthopaedics

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Purpose This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). Methods This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. Results We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8–20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. Conclusion A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. Level of evidence IV

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“…Jones et al [ 17 ] suggested that in situ pinning may result in impingement of moderate and severe (more than 30 degrees of Southwick angle) acute SCFE. The average final PTA was 21.5 degrees in the current cases, whereas postoperative PTA was 30.7 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…Even if the mild slip remained just after the surgery, femoroacetabular impingement could be avoidable through the remodeling of femoral head during the residual growth. [ 17 , 18 ]…”

Section: Discussionmentioning

confidence: 99%

Percutaneous pinning after prolonged skeletal traction with the hip in a flexed position for unstable slipped capital femoral epiphysis

Matsushita

Mishima

Iwata³

et al. 2017

Medicine

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Background:Unstable slipped capital femoral epiphysis (SCFE) has a relatively high risk of avascular necrosis of the femoral head. Standard treatment for unstable SCFE is still controversial. We reviewed unstable SCFE case series treated with the standardized protocol, which consisted of percutaneous pinning after prolonged skeletal traction.Methods:Our treatment regimen for unstable SCFE patients included 1 week or more of skeletal traction with the hip in a flexed position of 45 degrees, and subsequent percutaneous pinning after unintentional reduction. Eleven patients were treated in our institution and an affiliated hospital between 2003 and 2013. Sex, age at surgery, body mass index, the presence of hormonal abnormality, duration between onset and surgery, head shaft angle, posterior tilting angle, and modified Harris hip score were investigated from the medical records and radiographs.Results:There were 8 male and 3 female with an average age of 11.7 years and an average body mass index of 24.5 kg/mm2. No patients had hormonal abnormalities. The duration between onset and surgery ranged from 8 to 16 days. The average preoperative and postoperative head shaft angles were 126 and 141 degrees, respectively. Postoperative posterior tilting angle was averaged of 30.7 degrees, which decreased to 21.5 degrees during follow-up period. One patient showed mild avascular necrosis only confirmed by magnetic resonance imaging, but he was uneventfully treated without additional procedures. As a result, all patients had a perfect modified Harris hip score of 91 points.Conclusions:Prolonged traction with the hip in a flexed position may not only provide gradual reduction of posteriorly displaced epiphysis but also decrease intra-articular pressure before surgery. Although percutaneous pinning after unintentional reduction leaves mild displacement of the femoral epiphysis, remodeling could be expected during remaining growth period.

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Relationships Between Severity of Deformity and Impingement in Slipped Capital Femoral Epiphysis

Abstract: In this experimental model, moderate and severe acute slips in SCFE lead to reduced ROM and impingement with the acetabulum. This suggests that in situ pinning may result in impingement of moderate and severe acute SCFE slips.

Cited by 12 publications

References 23 publications

Evaluation of the Three‐Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis

Evaluation of the Three‐Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis

Hip arthroscopy following slipped capital femoral epiphysis fixation: Chondral damage and labral tears findings

Percutaneous pinning after prolonged skeletal traction with the hip in a flexed position for unstable slipped capital femoral epiphysis

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