Shear Stress in Epiphyseal Growth Plate is a Risk Factor for Slipped Capital Femoral Epiphysis

Zupanc, Oskar; Krizancic, M.; Daniel, Matěj; Mavčič, Blaž; Antolič, Vane; Iglič, Aleš; Kralj‐Iglič, Veronika

doi:10.1097/bpo.0b013e31816c4df8

Cited by 35 publications

(18 citation statements)

References 27 publications

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“…An LCEA of greater than 39°was found in 16.7% (four of 24) of the affected hips, 22.7% (five of 22) of the unaffected hips, and 6.5% (10 of 152) of the controls. Additionally, biomechanical etiology theories of SCFE have demonstrated increase in femoral retroversion, coxa vara, and varus displacement of the load vector will increase physeal shear forces [8,27,38]. The medialization of the femoral head of patients with SCFE (as demonstrated in our study by the increased LCEA) may cause varusization of the force vector, increasing the shear forces across the physis and therefore potentially increasing the risk for SCFE [8,13,25].…”

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confidence: 73%

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Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Monazzam

Venkatadass

Bittersohl

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Recent biplanar radiographic studies have demonstrated acetabular retroversion and increased superolateral femoral head coverage in hips with slipped capital femoral epiphysis (SCFE), seemingly divergent from earlier CT-based studies suggesting normal acetabular version. Question/purposes We therefore asked: Are there differences in (1) acetabular version at the superior 1 .4 of the acetabular dome (AV sup ), (2) acetabular version at the center of the femoral head (AV cen ), and (3) superolateral femoral head coverage (lateral center-edge angle [LCEA]) among affected SCFE hips, unaffected hips, and normal controls? Methods We identified 32 patients with SCFE who underwent CT between 2007 and 2012. Twenty-three met our inclusion criteria. Seventy-six age-and sex-matched normal patients comprised the control group. Pelvic rotation, tilt, and inclination were corrected on each CT. AV sup , AV cen , and LCEA were measured. Results The mean AV sup of the affected hips (À1.71°) demonstrated retroversion compared to the unaffected hips and the control group; the mean AV sup of the unaffected hips was similar to that of the normal controls. Mean AV cen was similar among the three groups. The LCEA was higher in affected and unaffected SCFE hips than in the control group (34.3°versus 34.5°versus 28.9°, respectively), but we found no difference between affected and unaffected hips. Conclusions Our data suggest an association of superior acetabular retroversion and increased superolateral femoral head coverage in SCFE. Whether this represents a primary abnormal morphology or a secondary pathologic response remains unclear. Further studies investigating the role of acetabular morphology in SCFE and its implications for development of symptomatic femoroacetabular impingement are warranted.

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confidence: 73%

“…While its origin remains an enigma [5,8,27,37,38], treatment methods have continued to evolve [21]. Gelberman et al [10] reported an association of SCFE and femoral retroversion.…”

Section: Introductionmentioning

confidence: 99%

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Monazzam

Venkatadass

Bittersohl

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Other biochemical or biomechanical factors such as shear stress to the affected and to the opposite hip that contribute to the development of OA may be at work and need further investigation [25,26].…”

Section: Discussionmentioning

confidence: 99%

Significance of clinical and radiographic findings in young adults after slipped capital femoral epiphysis

Zilkens

Bittersohl

Jäger

et al. 2010

International Orthopaedics (SICOT)

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The purpose of this study was to assess the clinical and radiographic presentation of young adults in the mid-term follow-up after pinning in situ for mild to moderate slipped capital femoral epiphysis (SCFE). We postulated that there was a correlation between the degree of head-neck-offset decrease and clinical and radiographic signs of hip joint degeneration. Thirty-eight young adults (average age 23.4±3.6 years old) with various grades of femoral head-neck-offset pathologies were assessed clinically via Harris hip score (HHS), Tegner-Lysholm score (TLS) and Short Form 36 (SF-36), and radiographic signs of OA were measured on plain X-ray films after a follow-up of 11.1±3.8 years. We conclude that clinical and radiographic signs of joint degeneration appear early in the follow-up after SCFE, but there is no linear correlation between offset-pathology and joint degeneration.

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“…Increased body mass can cause the phenomenon of repetitive microtrauma through the proximal femoral physis to occur with increasingly greater forces. This mechanism, combined with relative femoral retroversion seen in overweight adolescents and the resulting elevated shear stresses, causes physeal chondrocyte apoptosis, biomechanical instability of the physis, and subsequent anterosuperior displacement of the proximal femoral metaphysis relative to the capital epiphysis, which remains contained in the acetabulum [1,19,20,50]. BL-SCFE can occur at the initial presentation, which we labeled concurrent SCFE in the current study, or over time in the contralateral hip, which we labeled sequential SCFE.…”

Section: Discussionmentioning

confidence: 99%

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

Nasreddine

Heyworth

Zurakowski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE. Questions/purposes We therefore determined whether (1) BMI percentile was a risk factor for BL-SCFE; and (2) postoperative increases and/or decreases in BMI percentile influenced the risk for BL-SCFE. Methods We retrospectively reviewed the records of 502 patients surgically treated for SCFE and identified 138 (27%) with BL-SCFE and 364 (73%) with unilateral SCFE (UL-SCFE); 173 patients, 60 (35%) with BL-SCFE and 113 (65%) with UL-SCFE met our inclusion criteria. Risk factors included sex, age, slip stability, slip chronicity, slip angle, and obesity. Percentile BMI was recorded at the time of first SCFE surgery, at the time of last followup for patients undergoing UL-SCFE, and at the time of second SCFE surgery for patients undergoing BL-SCFE. Results Sex, age, slip stability, and slip angle were not associated with BL-SCFE. Postoperative obesity (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2-9.7) and acute slip chronicity (OR, 2.9; 95% CI, 1.3-6.7) had higher risks for sequential BL-SCFE. Obese patients who became nonobese postoperatively had a decreased risk of sequential BL-SCFE compared with those who remained obese (OR, 0.16; 95% CI, 1.2-116.5). Conclusions Only postoperative obesity and an acute slip were risk factors for sequential BL-SCFE. BMI reduction to lower than the 95% percentile after SCFE surgery was associated with lower risk for BL-SCFE development. The data suggest early supervised therapeutic weight management programs for patients treated for UL-SCFE are important to reduce risk of subsequent SCFE. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Shear Stress in Epiphyseal Growth Plate is a Risk Factor for Slipped Capital Femoral Epiphysis

Abstract: III (prognostic study, case-control study).

Cited by 35 publications

References 27 publications

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Significance of clinical and radiographic findings in young adults after slipped capital femoral epiphysis

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

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