PurposeThe purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated.MethodsSixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg epiphysiodesis (30 hips), and bone-peg epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA).ResultsIn 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg epiphysiodesis. Eight patients with large chronic slip (mean slip angle 53°) were treated with bone-peg epiphysiodesis and corrective femoral osteotomy, and the clinical outcome was poor in six patients. Seven patients with acute slip had larger mean slip angle (57°) and more complications than those with chronic slip, and the long-term outcome was poor in all. Two hips out of 42 (5%) had OA in the contralateral hip at follow-up.ConclusionIn situ fixation of chronic SCFE gave satisfactory long-term outcome irrespective of the treatment method. Corrective femoral osteotomy did not improve the outcome in hips with large slip angles. Acute SCFE had poor outcome. Prophylactic fixation of the contralateral hip is barely necessary.

PurposeThere is no consensus regarding prophylactic fixation of the contralateral hip in slipped capital femoral epiphysis (SCFE). In order to further study this question, we evaluated the long-term natural history of untreated contralateral hips.MethodsForty patients treated for unilateral SCFE without evidence of subsequent contralateral slip during adolescence were reviewed with a mean follow-up of 36 years (range 21–50 years). The deformity after SCFE may demonstrate radiographic signs of cam-type femoroacetabular impingement. We, therefore, measured α-angles in the contralateral hips on anteroposterior (AP) and frog-leg lateral radiographs. The angles were compared with those of a control group of adults without SCFE. Five years after the radiographic examination, with a mean follow-up of 41 years, all patients were evaluated by telephone interview. As range of motion and deformity could not be examined, a modified Harris hip score (HHS) (maximum score of 91 points) was used. A modified HHS <76 points and/or radiographic osteoarthritis (OA) was classified as a poor long-term outcome.ResultsThe mean value of the AP α-angle was significantly higher in the contralateral hips in SCFE patients than in the control group (55° vs. 46°), while the mean value of the lateral α-angle was not. Abnormally high values for one or both α-angles were found in 16 contralateral hips (40 %), of which five patients had abnormal values for both α-angles and were considered to have had an asymptomatic contralateral slip. Five patients (13 %) had a poor outcome in the contralateral hip, of which three patients (8 %) had OA. There was a significant association between hips with both α-angles that were abnormal and poor outcome.ConclusionsSince the natural history showed good long-term radiographic and clinical outcome in 35 of 40 patients and only three had OA, we conclude that routine prophylactic fixation of the contralateral hip is not indicated.

Deformity after slipped upper femoral epiphysis (SUFE) can cause cam-type femoroacetabular impingement (FAI) and subsequent osteoarthritis (OA). However, there is little information regarding the radiological assessment and clinical consequences at long-term follow-up. We reviewed 36 patients (43 hips) previously treated by in situ fixation for SUFE with a mean follow-up of 37 years (21 to 50). Three observers measured the femoral head ratio (FHR), lateral femoral head ratio (LFHR), α-angle on anteroposterior (AP) and frog-leg lateral views, and anterior femoral head-neck offset ratio (OSR). A Harris hip score < 85 and/or radiologically diagnosed osteoarthritis (OA) was classified as a poor outcome. Patients with SUFE had significantly higher FHR, LFHR and α-angles and lower OSR than a control group of 22 subjects (35 hips) with radiologically normal hips. The interobserver agreement was less, with wider limits of agreement (LOA), in hips with previous SUFE than the control group. At long-term follow-up abnormal α-angles correlated with poor outcome, whereas FHR, LFHR and OSR did not. We conclude that persistent deformity with radiological cam FAI after SUFE is associated with poorer clinical and radiological long-term outcome. Although the radiological measurements had quite wide limits of agreement, they are useful for the diagnosis of post-slip deformities in clinical practice.

PurposePredictive factors for long-term outcome after in situ fixation for chronic slipped capital femoral epiphysis (SCFE) have so far not been systematically analysed. The aims of this study were to define predictors for long-term outcome and to assess the association between initial grade of slipping and post-slip deformities.MethodsWe studied 51 patients (60 hips) with chronic SCFE treated with in situ fixation. There were 31 males and 20 females with a mean age of 12.9 years. The mean follow-up was 39.0 years (21.1 to 56.8). Post-slip deformity was defined as abnormal alpha (a) angles in anteroposterior (AP) and lateral radiographs; AP angle of 74° and lateral angle of 63° were used as cutoffs between normal and abnormal α-angles. Harris hip score (HHS) less than 85 points was classified as a poor clinical outcome and osteoarthritis was a poor radiographic outcome.ResultsThe mean slip angle was 31.7° (12° to 77°). The mean AP α-angle was 67.4° (36° to 111°) and the mean lateral α-angle was 57.1° (22° to 104°). Post-slip deformities developed in almost one-third of hips with a mild degree of slipping and in about half the hips with more pronounced degrees of slipping. The long-term outcome was good in 40 hips (67%) and poor in 20 hips. A small AP α-angle was the only independent prognostic factor for a good combined clinical and radiographic outcome.ConclusionPost-slip deformity, defined as an abnormally high AP α-angle, is the most important prognostic factor for poor long-term clinical and radiographic outcome in chronic SCFE treated with in situ fixation.

Purpose We modified the method for tibial epiphysiodesis by solely using a lateral approach to the physis. From this small-incision approach, the lateral as well as the medial part of the tibial physis were ablated. The aim of our study was to see if this operative technique might be as effective as a bilateral approach, and reduce the operation time and usage time of the image intensifier. The epiphysiodeses were monitored by radiostereometric analysis (RSA), which is a well-established method for the analysis of micro movements and has been used to monitor percutaneous epiphysiodesis with the bilateral approach. There are no reports in the literature comparing single-with double-portal approaches for percutaneous epiphysiodesis evaluated by RSA. Methods Twenty children were treated by percutaneous epiphysiodesis for leg length discrepancies ranging from 15 to 70 mm, comprising 14 boys and 6 girls with a mean age of 13 (11-15) years. The timing of epiphysiodesis was determined by using Moseley's straight-line graph and Paley's multiplier method. For the tibial epiphysiodesis, ten patients were operated with a single surgical approach from the lateral side (Group I) and ten patients were operated with a surgical approach from both the medial and the lateral sides (Group II). The percutaneous epiphysiodesis was monitored by RSA, a method which allows analysis of the three-dimensional dynamics of the epiphysis relative to the metaphysics. RSA examinations were performed postoperatively and after 6 weeks, 12 weeks, and 6 months.Results From 0 to 6 weeks after epiphysiodesis, the mean longitudinal growth across the operated physis in the tibia in Group I was 0.26 (0.01-0.6) mm. In Group II, the mean growth for the first 6 weeks after surgery was 0.17 (0.01-0.5) mm. During the time period from 6 weeks to 12 weeks after surgery, there was a mean growth of 0.06 (0.00-0.18) mm in Group I and 0.03 (0.00-0.2) mm in Group II. The mean growth from 0 to 6 weeks after epiphysiodesis for all patients was 0.22 mm, which corresponds to 30 % of the normal growth rate. From 6 to 12 weeks, the mean growth for all patients was 0.046 mm, i.e., 6 % of the normal growth rate. From 12 weeks to 24 weeks, no significant growth across the operated physis was observed in neither Group I nor Group II. The mean surgical time was 26 (21-30) min in Conclusions In our study, a single-portal technique from the lateral side for percutaneous epiphysiodesis of the proximal tibia was as effective as the double-portal technique. Actual growth arrest appeared within 12 weeks after surgery. A single-portal technique for epiphysiodesis of the tibia is a safe technique, with less surgical time and less time for image intensification compared to the doubleportal technique.