Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis

Abstract

The stages in adolescent slipping of the upper femoral epiphysis are classified in relation to treatment. The operation of open replacement of the displaced femoral head is described, and the results of a personal series of seventy-three such operations are presented. Open replacement is excellent treatment for severe chronic slipping so long as the growth plate is still open. The greater incidence of avascular necrosis in acute-on-chronic cases is probably due to damage to the blood supply of the head at the time of the acute slip or kinking of the vessels before replacement. Prolonged traction before operation may increase the risk of chondrolysis. Late onset of osteoarthritis when neither avascular necrosis nor chondrolysis has occurred may be due to misfitting of the articular cartilage because of inaccurate reduction.

Hip impingement in slipped capital femoral epiphysis: A changing perspective

“…Although common in severe slips, this can be seen in mild slips as well [20][21][22]. In addition, posteromedial callus formation, as a part of the chronic reactive healing process of SCFE, places tension on the posterosuperior retinaculum, which contains the blood supply to the femoral head, complicating potential corrective surgical options [12,13,22].…”

“…In addition, the question arises as to the exact role of proximal femoral osteotomies (i.e., Southwick, Imhäuser, Kramer/Barmada, Dunn) in the treatment of SCFE and FAI [13,[17][18][19] The purpose of this paper is to briefly review the most recent evidence regarding our evolving understanding of FAI in SCFE and to discuss different treatment strategies.…”

Radiographic Assessment of Coxarthrosis following Slipped Capital Femoral Epiphysis

“…The presence of degenerative changes on radiographs is often used to evaluate the results of treatment of SCFE (3,6,7,10,13,18,23,25). When assessing these changes it is important.to have standardized techniques and methods of measurement in order to make valid comparisons of data from different studies.…”

“…Several previous studies have used subjective, visual assessment of their radiographs in identifying degenerative changes (6,7,10,23,25). Although the internal accuracy and consistency may be excellent, extrapolation to a different viewer's subjective assessment is not feasible (1 5).…”

“…Treatment aims at preventing the risk of OA and results of treatment are frequently assessed by radiographic examination (3,6,7,10,18,23). The presence of OA in younger patients implies an unsatisfactory outcome (25).…”