Surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz: a systematic review

Abstract

Background Treatment of SCFE is still controversial, especially in moderate and severe forms. Dunn osteotomy performed with the Ganz approach became very popular in the last decade, although it is a complicated and challenging surgical procedure with a risk of AVN. The aim of our study was to analyze the current literature verifying the effectiveness of this surgical procedure, with specific attention to the incidence of AVN and other complications. Main body A systematic review on the subject was performed according to the PRISMA guidelines. A literature search was performed by searching all published articles about the topic in the databases. The articles were screened for the presence of the following inclusion criteria: patients affected by slipped capital femoral epiphysis (SCFE) surgically treated by Dunn osteotomy using the Ganz surgical approach. All the patients affected by pathologies other than SCFE, treated without surgery or with procedures not including a surgical hip dislocation were excluded. Based on inclusion and exclusion criteria, 23 studies were included in our systematic review. Selected articles were published from 2009 to 2021 and they included 636 overall hips. According to the selected articles, Dunn osteotomy modified by Ganz, performed by an experienced surgeon, allows for anatomical reduction of moderate or severe SCFE with a low incidence of AVN. Conclusions The few papers with long term follow-up, reported no progression of hip osteoarthritis, however, since the patients are adolescent at surgery, longer follow-up studies are needed to validate this statement. It is still debated if better results are obtained in stable or unstable SCFE. The indication of this procedure in mild SCFE remains controversial. Level of evidence 3

Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications

“…In our small series of SCFE operated on by MDP, we had almost 90% of excellent-good results, in line with the current literature. AVN occurred in 7% of cases while hip instability (HI), in 14%; these are the reverse of the numbers reported by the recent systematic reviews and meta-analyses of the literature [13,14]. However, our statistics are biased by the low number of our patients who underwent MDP.…”

“…In 2001, Ganz et al [11] described the "surgical dislocation" of the hip with all the tips and tricks to preserve the integrity of the retinacular vessels, while in 2007 Leunig et al [12] applied the technique defined "modified Dunn procedure" (MDP) to the open reduction and fixation of moderate and severe SCFE, reporting anatomic reduction of CFE and 0% prevalence of AVN. Recent systematic reviews and meta-analyses of the literature on MDP [13,14] have shown overall satisfactory results, but with a mean prevalence of AVN ranging from 10.8% to 14.3%. However, the prevalence of AVN was almost double in acute cases (19.9%) [14], as confirmed by another recent meta-analysis on acute SCFE treated by MDP [26].…”

“…Meanwhile, systematic reviews and meta-analyses of the literature on MDP have reported good results in most of the operated cases [13,14], and the first long-term follow-up studies have reported only a few cases of mild osteoarthritis after MDP [15][16][17]. However, as MDP has gradually been performed by a larger number of surgeons throughout the world, AVN, the most feared complication of MDP that was absent in the first reports by Leunig et al [12], has increased to a mean ranging from 10.8% [13] to 14.3% [14]. Hip instability (HI), the second most feared complication, has been reported at a mean of 6.8% [13], although its etiopathogenesis has not been fully clarified.…”

“…However, as MDP has gradually been performed by a larger number of surgeons throughout the world, AVN, the most feared complication of MDP that was absent in the first reports by Leunig et al [12], has increased to a mean ranging from 10.8% [13] to 14.3% [14]. Hip instability (HI), the second most feared complication, has been reported at a mean of 6.8% [13], although its etiopathogenesis has not been fully clarified.…”

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips

“…Although significant improvement can be observed in radiological outcomes, controversy still exists whether or not better outcomes can be obtained in stable and unstable slips, and additionally the number of long-term follow-up studies is very limited in this novel surgical technique. 4,23,24 Modified Dunn procedure was only taken into consideration in severe slips by the respondents in the present study, but a weak to moderate disagreement on the use of this procedure in all severe stable and unstable slip scenarios was observed. Therefore, respondents of the present study seem to be influenced from the limited current scientific evidence about the wider use of modified Dunn procedure in severe type of SCFE.…”