Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis

Leunig, Michael; Casillas, Mark M.; Hamlet, Marc; Hersche, Otmar; Nötzli, Hubert; Slongo, Theddy; Ganz, Reinhold

doi:10.1080/000164700317393367

Cited by 498 publications

(344 citation statements)

References 16 publications

(14 reference statements)

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“…In addition, a case series of three hips with mild slips undergoing surgical hip dislocation for treatment of a recent diagnosis of SCFE showed degenerative changes to the labrum in two hips and acetabular cartilage damage in all three hips [21]. An MRI study of 35 hips evaluated 12 years after treatment for mild or moderate SCFE also noted 24 hips had superior acetabular cartilage damage [28].…”

Section: Discussionmentioning

confidence: 99%

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear. Questions/purposes We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning. Methods We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2-43 years).

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Section: Discussionmentioning

confidence: 99%

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Baghdadi

Larson

Sierra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Specifically, FAI is associated with a pathomechanical hip environment in which there is abnormal, repetitive abutment between the anterolateral femoral head-neck junction and the anterolateral rim of the acetabulum [17,36]. These abnormal joint mechanics stem from a heterogeneous group of structural abnormalities in which there is a femoral-based (cam), acetabular-based (pincer), or combined impingement deformity [28,34,36,37]. These deformities initiate a cascade of degenerative, intraarticular events including disruption of the labrochondral junction.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Femoroacetabular Impingement: A Systematic Review of the Literature

Clohisy

John

Schutz

2010

Clinical Orthopaedics &Amp; Related Research

267

203

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The surgical treatment of femoroacetabular impingement has become more common, yet the strength of clinical evidence to support this surgery is debated. We performed a systematic review of the literature to (1) define the level of evidence regarding hip impingement surgery; (2) determine whether the surgery relieves pain and improves function; (3) identify the complications; and (4) identify modifiable causes of failure (conversion to total hip arthroplasty). We searched the literature between 1950 and 2009 for all studies reporting on surgical treatment of femoroacetabular impingement. Studies with clinical outcome data and minimum two year followup were analyzed. Eleven studies met our criteria for inclusion. Nine were Level IV and two were Level III. Mean followup was 3.2 years; range (2-5.2 years). Reduced pain and improvement in hip function were reported in all studies. Conversion to THA was reported in 0% to 26% of cases. Major complications occurred in 0% to 18% of the procedures. Current evidence regarding femoroacetabular impingement surgery is primarily Level IV and suggests the various surgical techniques are associated with pain relief and improved function in 68-96% of patients over short-term followup. Long-term followup is needed to determine survivorship and impact on osteoarthritis progression and natural history.

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“…The concept of osteoarthritis of the hip as an end result of hip impingement (which developed as a result of abnormal anatomy of the proximal femur and acetabulum) has been supported by several reports [1,[4][5][6]. Anatomic variations in femoral head-neck offset, acetabular retroversion, and femoral anteversion are postulated to lead to abnormal hip mechanics with subsequent abutment, labral tears, and the development of early arthrosis [2,3,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Anatomic variations in femoral head-neck offset, acetabular retroversion, and femoral anteversion are postulated to lead to abnormal hip mechanics with subsequent abutment, labral tears, and the development of early arthrosis [2,3,[6][7][8][9]. Similarly, the posteromedial displacement of the epiphysis in a typical SCFE places the metaphysis in a pathologic anterolateral position [1,10]. This not only places the femur in retroversion and varus (leading to a clinical loss of internal rotation), but also leads to a loss of hip flexion as the prominent anterolateral metaphysis impinges against the acetabular rim, leading to progressive degenerative changes [1,10].…”

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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Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis

Cited by 498 publications

References 16 publications

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Surgical Treatment of Femoroacetabular Impingement: A Systematic Review of the Literature

Hip impingement in slipped capital femoral epiphysis: A changing perspective

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