We reviewed, at an average age of 46 years, a series of 61 patients treated for unilateral slipped upper femoral epiphysis. At maturity there had been slipping of the contralateral hip in 11 patients (18%) and another 14 (23%) had originally had evidence of bilateral slipping when the primary radiographs were reviewed. In only two of these 25 patients (8%) was the slipping of the contralateral hip symptomatic. The incidence of early osteoarthritis of the contralateral hip was 7 of 36 with no slip, 5 of 16 with an untreated slip and 1 of 9 with a slip pinned in situ. If all 61 contralateral hips had been prophylactically pinned at the primary admission, 36 of the operations (59%) would have been unnecessary. We recommend that prophylactic pinning of the contralateral hip should not be standard, but that lateral radiography by the Billing technique be repeated every third to fourth month until closure of the growth plate begins. Hips in which a slip occurs should be pinned in situ.

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We reviewed the radiological and clinical long-term results after the nailing in situ of slipped upper femoral epiphysis in 59 hips in 43 patients. The displacement of the epiphysis had been measured as the 'slipping angle' before operation and related to the results at follow-up at a mean of 30.9 years (27 to 34). The mean age at follow-up was 44.2 years (39 to 50). Radiographic re-examination of 41 hips with slipping angles of < or =30 degrees at the time of operation showed that eight (20%) had developed mild osteoarthritis and one had severe changes. For 18 hips with slipping angles ranging from 31 to 50 degrees at surgery six (33%) had mild osteoarthritis and three had severe changes. The differences did not quite achieve statistical significance (p = 0.09). Clinical re-examination of the 41 hips with slipping angles of < or =30 degrees showed fair or poor results (Harris hip score <90) in three (7%). In the 18 hips with slipping of 31 to 50 degrees, four had fair or poor results (22%) (p = 0.13). We conclude that nailing in situ for slipping of < or =30 degrees, using one thin nail, can give excellent long-term results. At present we recommend that hips with slips ranging from 31 to 50 degrees should also be nailed in situ, but further long-term studies are required, especially on the choice between nailing in situ and corrective osteotomy for slips in excess of 50 degrees.

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