Subclinical bilateral involvement of the hip in patients with slipped capital femoral epiphysis—a multicentre study

Kohno, Yusuke; Kitano, Takao; Nakamura, Tomoyuki; Takamura, Kei; Akiyama, Mio; Hara, Daisuke; Yamamoto, Takuya; Motomura, Goro; Ohishi, Masanobu; Hamai, Satoshi; Iwamoto, Yukihide

doi:10.1007/s00264-013-2131-y

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…Several studies have demonstrated the significance of the posterior sloping angle (PSA) of the unaffected hip in predicting sequential SCFE. 8 , 10 , 12 , 21 , 22 Park et al 8 stated that PSA is predictive of sequential SCFE in patients presenting with unilateral SCFE. They recommend considering prophylactic screw fixation in females with PSA greater than13º upon presentation.…”

Section: Resultsmentioning

confidence: 99%

Probability analysis of sequential SCFE (PASS score)

Danino

Singh

Shi

et al. 2020

Journal of Children's Orthopaedics

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Purpose The study aimed to develop a scoring system based on clinical and radiological findings to predict the risk of a sequential slipped capital femoral epiphysis (SCFE). Methods Paediatric patients with unilateral SCFE and at least two years of radiographic follow-up were screened for inclusion. Medical records were reviewed for multiple variables including age, gender, body mass index (BMI), stability of SCFE, and time to sequential presentation. Radiographic analysis included triradiate physeal status, Risser staging, superior epiphyseal extension ratio (EER), posterior epiphyseal angle (PEA), posterior sloping angle (PSA) and slip severity. Results In total, 163 patients (88 male, 54%, 75 female, 46%) met inclusion criteria. Of those, 65 (40%) with a mean age of 11.9 ± 1.3 years developed sequential SCFE at a mean of 9.8 ± 6.4 months after the initial slip. Eight independent variables were statistically different (p < 0.05) between unilateral and sequential groups. Following multivariate analysis, Risser stage and triradiate status were no longer significant and did not influence the strength of the final model (overall area under the curve (AUC) = 0.954) and were consequently excluded. We developed the PASS score using three radiographic parameters using chosen cut-off values that were close to their maximized value and weighted the point value assigned to each parameter based on the strength of predictor. Conclusion A PASS score of three or higher predicts a high probability of sequential SCFE with 95% confidence and may warrant prophylactic screw fixation. PASS score calculation can be used to predict a sequential SCFE and provide an objective method to determine the utility prophylactic screw fixation. Level of Evidence II

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Section: Resultsmentioning

confidence: 99%

Probability analysis of sequential SCFE (PASS score)

Danino

Singh

Shi

et al. 2020

Journal of Children's Orthopaedics

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“…Kohno et al found that ~70% of contralateral hips in unilateral SCFE patients had a subclinical posterior inclination of the capital femoral epiphysis, indicating the possibility of bilateral involvement. The contralateral posterior sloping angle was a reliable predictor of a contralateral slip, and an angle of 19° was the cutoff value for developing SCFE 12…”

Section: Etiology and Histopathologymentioning

confidence: 94%

<p>Slipped capital femoral epiphysis: current management strategies</p>

Aprato

Conti²,

Bertolo³

et al. 2019

ORR

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In orthopedic literature, there is little consensus regarding the best management of slipped capital femoral epiphysis (SCFE). Controversies and disparate trends derive from differences in clinical presentation, various classifications, and a variety of surgical procedures that have been described. Currently, there are no evidence-based recommendations. Surgical procedures vary, and they can be divided into fixation in situ, compensatory osteotomies, and direct corrections of the deformity at the head–neck junction. The first and second group of procedures have so far not gained optimal control over the risk of avascular necrosis or cannot achieve an anatomically aligned epiphysis with normal blood supply. On the other hand, the third technique can achieve this target and prevent residual deformity and the development of early hip arthritis, but it is not widely accepted, because of its surgical complexity. The purpose of this work is to present an overview of current knowledge and provide an orientation on clinical and surgical management of the patient suffering from SCFE.

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“…Epiphyseal tilt in the anterior plane was found to be slightly higher in the contralateral asymptomatic hips, meaning that on average, the epiphysis is a little more posteriorly tilted in comparison to the matched group. Two studies showed a more posteriorly tilted epiphysis assessed by higher posterior sloping angle in the contralateral hip in patients with unilateral SCFE compared with control hips [3,17]. Increased posterior epiphyseal tilt (higher posterior sloping angle) is associated with an increased risk of sequential contralateral SCFE [4], and the posterior sloping angle has been used as a recommendation for prophylactic fixation, although conflicting threshold values have been reported [3,4,20,28,29,38].…”

Section: Volume 476 Numbermentioning

confidence: 99%

“…The posterior sloping angle, which measures orientation of the femoral head in relation to the neck-diaphysis axis, has been used as a predictor for the risk of sequential SCFE [3,4,20,28,29,38]. Although two studies showed higher posterior sloping angle in the contralateral hip of patients with unilateral SCFE in comparison to control normal hips [3,17], there are limited data regarding morphologic features of the contralateral hip assessed by contemporary measurements of femoroacetabular impingement (FAI) [7,10,36]. Elevated a angle suggesting FAI with cam-type morphologic features in the contralateral hips of patients with unilateral SCFE was reported in two long-term studies [10,36].…”

Section: Introductionmentioning

confidence: 99%

Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study

Hesper

Bixby

Maranho

et al. 2018

Clin Orthop Relat Res

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Although we noted a difference in the morphologic features of the head-neck junction between the two groups, the clinical significance is unclear because most differences were rather small. However, our findings suggest that the uninvolved hip in patients with unilateral SCFE may have a subtle asymptomatic cam morphologic feature that may be identified only with advanced imaging (CT or MRI). Future studies should investigate whether these morphologic changes influence development of contralateral SCFE or symptomatic femoroacetabular impingement in the contralateral hip of patients with unilateral SCFE and establish thresholds for indication of prophylactic fixation to avoid further slip and worsening of the morphologic features of the cam-femoroacetabular impingement.

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Subclinical bilateral involvement of the hip in patients with slipped capital femoral epiphysis—a multicentre study

Abstract: These findings suggested the possibility of bilateral hip involvement in SCFE patients. Hips with greater degrees of PSA (> 19°) are likely to become symptomatic.

Cited by 14 publications

References 28 publications

Probability analysis of sequential SCFE (PASS score)

Probability analysis of sequential SCFE (PASS score)

<p>Slipped capital femoral epiphysis: current management strategies</p>

Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study

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