Controversies exist regarding the best treatment for slipped capital femoral epiphysis (SCFE). Subcapital anatomical reorientation of the epiphysis by surgical dislocation and a retinacular soft tissue flap has been described recently as an effective approach. We evaluated the clinical and radiographic efficacy of this technique and compared these to published results. A series of 20 SCFE (18 stable, 2 unstable) treated by subcapital re-orientation through surgical hip dislocation and an extended retinacular soft tissue flap was reviewed retrospectively. Preoperatively and at most recent follow-up, patients were clinically examined with regard to pain and function according to the Harris hip score and to the Western Ontario and McMaster universities (WOMAC) score. Radiological examination included measurement of preoperative and postoperative anteroposterior (AP) and lateral (L) Southwick angles; and at follow-up the alpha angle was measured. The average follow-up time was 24 months. The mean WOMAC score was 2.80 post-operatively. The mean pre-operative slip angle was 40.2 degrees on the AP view and 50.65 degrees on the lateral view. Post-operatively, the mean values were 7,20 degrees on the AP view and 9,45 degrees on the lateral view. The mean post-operative average alpha angle was 43,11 degrees. No cases of avascular necrosis were seen. Our short term clinical and radiographic results are similar to outcomes published in the recent literature. The small number of technical complications appears favourable considering the surgical complexity of the procedure, and our technique offers clear advantages in treating these complex deformities.

Background: Revisions of hip prostheses are increasing, and conventional radiography (CR) is a primary tool for managing complications. However, dual-energy CT (DECT) with virtual monoenergetic imaging is capable of reducing periprosthetic metal artifacts compared with standard CT.Purpose: To compare the diagnostic performance of DECT and CR in detecting hip prosthesis loosening, using surgery as a reference for diagnosis. Materials and Methods:This retrospective single-center study conducted between January 2018 and October 2020 included consecutive patients with unilateral painful hip prostheses. Two independent readers (with 15 years and 4 years of experience) who were blinded to clinical findings evaluated CR and DECT images. At imaging, diagnosis of loosening prosthesis was made for periprosthetic radiolucency greater than or equal to 2 mm wide or the presence of two or more secondary findings, including periprosthetic osteolysis, angulation of the implant, fracture, or abnormal periosteal reaction. For each reader and for each imaging parameter, sensitivity and specificity were calculated. The diagnostic performance of each imaging tool was compared by using the McNemar test. Interobserver agreements were calculated with Cohen κ statistics. Statistical software was used.Results: Overall, 178 patients (mean age ± standard deviation, 74 years ± 20; 96 men) were included (121 undergoing surgery, 57 follow-up). Overall, 87 of 178 patients (49%) were diagnosed with a loosened prosthesis. DECT had higher sensitivity and specificity than CR for both reader 1

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At 1.5 Tesla hip MRA, the accuracy of IW-3D and Hy-3D images was not significantly higher than the 2D sequences in evaluating acetabular labrum and chondral lesions.