The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan.

Background Multiple mechanical factors affecting the hip have been associated with the development of slipped capital femoral epiphysis (SCFE). Whether acetabular depth plays a role in the development of a SCFE has not been elucidated. Questions/purposes (1) What is the prevalence of a deep acetabulum in SCFE? (2) Is the presence of a deep acetabulum associated with physeal instability? (3) Is the presence of a deep acetabulum associated with the occurrence of a contralateral SCFE? Methods We retrospectively reviewed 232 patients (156 males) who presented with a unilateral SCFE. Fifty (22%) subsequently developed a contralateral SCFE. The involved and uninvolved sides were evaluated for the presence of a deep acetabulum (DA). Preoperative radiographic parameters, slip stability, development of a contralateral SCFE, and demographic factors were then compared between patients with and without DA.Results DA was present in 120 hips (52%) with a SCFE. DA was more common in females (55 of

Section: Discussionsupporting

confidence: 83%

Increased Acetabular Depth May Influence Physeal Stability in Slipped Capital Femoral Epiphysis

Podeszwa

Gurd

Riccio

et al. 2013

“…This should be sufficient to detect contralateral slips, which typically occur within 18 months of the first slip [6,13,22,24,31,42]. We reviewed medical records to determine the rate of a subsequent contralateral slip.…”

Section: Methodsmentioning

confidence: 99%

“…avascular necrosis and severe hip deformity [2]. For the most part, a low rate of severe slips (0%-3%) has been reported for the contralateral hip [13,17,24], perhaps since children and parents are aware of the condition and able to report for treatment as soon as symptoms develop. Thus, since severe slips are rare, expectant management of a contralateral hip at risk for slipping has been well accepted, particularly for older children and those without associated risk factors of an endocrinopathy.…”

Section: Introductionmentioning

confidence: 99%

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

Baghdadi

Larson

Sierra

et al. 2013

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).

“…It is known to affect boys more often that girls with a maleto-female ratio of approximately 1.5 [40,46], although unstable slips seem to be at least as common in females as in males. The prevalence of bilateral SCFE has been reported from 20% to 80% and in bilateral cases, the second SCFE usually occurs during the first year after the first slip [49]. There is a racial variability with a higher prevalence rate in blacks, Hispanics, Polynesians, and Native Americans when compared with whites [8,40,46].…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

“…Once SCFE is diagnosed in one hip, prophylactic treatment of the contralateral hip should be considered strongly because of the high prevalence of bilateral SCFE. Although prophylactic pinning of the contralateral hip is still controversial [18,36,49], young age at diagnosis, unstable SCFE, endocrine disorders, and unreliable patient followup are relative indications for prophylactic treatment [49]. The increasing incidence of SCFE and childhood obesity [8,61,63] reinforces the necessity for promoting population-level health policies to support childhood obesity prevention [56].…”

Section: How Do We Get There?mentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

133

Background Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term. Questions/Purposes We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment. Methods A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively. Where Are We Now? A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE. Where Do We Need to Go? Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes. How Do We Get There? Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.