Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis

Abstract

ObjectivesThe purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).MethodsThe electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies.ResultsFifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively.ConclusionIn the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety.Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1.

A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery

“…76 Last, the surgical treatment of FAI after slipped capital femoral epiphysis with a surgical hip dislocation had the greatest alpha angle correction of 41.45° ± 10.5°, although with the highest complication rate (6.7%) compared with arthroscopic surgery (1.6%). 69…”

“…76 Last, the surgical treatment of FAI after slipped capital femoral epiphysis with a surgical hip dislocation had the greatest alpha angle correction of 41.45 ± 10.5 , although with the highest complication rate (6.7%) compared with arthroscopic surgery (1.6%). 69 FAI Outcomes. Hip arthroscopic surgery for the treatment of FAI resulted in a postoperative mean alpha angle of 45:6 ± 8:2 (range, 36:4 -68:5 ), femoral offset of 8:8 ± 0:9 mm (range, 7.8-9.56 mm), and lateral center-edge angle of 34:1 ± 6:2 (range, 30:3 -35:9 ).…”

The Outside-In Technique for Slipped Capital Femoral Epiphysis: A Safe and Reproducible Approach in Hip Arthroscopy

“…It is doubled-checked with the image intensifier in all x-ray planes (Figure 5, Table 2, Video 1). [7][8][9]…”

Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis

“…The standard of care therefore became in situ pinning of the epiphysis with or without a gentle attempt at partial closed reduction in cases of acute displacement [5]. This reduced the occurrence of catastrophic complications, but often left the patients w ith femoral deformity le ading t o femoroacetabular impingement (FAI) [5,9]. FAI associated with SCFE has been described as 'impaction', when the metaphysis abuts against the acetabular rim, or as 'inclusion', when the remodeled metaphysis enters the joint and conflicts with the articular cartilage [10].…”