Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis

Abstract

Background and purposeThe best treatment option for severe slipped capital femoral epiphysis (SCFE) is still controversial. We compared clinical and radiographic outcomes of modified Dunn procedure (D) and in situ fixation (S) in severe SCFE.Patients and methodsWe retrospectively compared D and S, used for severe stable SCFE (posterior sloping angle (PSA) > 50°) in 29 patients (15 D; 14 S). Propensity analysis and inverse probability of treatment weights (IPTW) to adjust for baseline differences were performed. Patients were followed for 2–7 years.ResultsAvascular necrosis (AVN) occurred in 3 patients out of 15, after D, causing conversion to total hip replacement (THR) in 2 cases. In S, 1 hip developed chondrolysis, requiring THR 3 years after surgery. 3 symptomatic femoroacetabular impingements (FAI) occurred after S, requiring corrective osteotomy in 1 hip, and osteochondroplasty in another case. The risk of early re-operation was similar between the groups. The slippage was corrected more accurately and reliably by D. The Nonarthritic Hip Score was similar between groups, after adjusting for preoperative and postoperative variables.InterpretationAlthough D was superior to S in restoring the proximal femoral anatomy, without increasing the risk of early re-operation, some concern remains regarding the potential risk of AVN in group D.

Clinical and radiological outcomes of chronic severe slipped capital femoral epiphysis patients treated by surgical dislocation and modified Dunn osteotomy: Case series

“…In our study, the mean preoperative Southwick angle was 59.1° (range, 50.6° to 75°). This finding was comparable with the results of other studies: Novais et al[ 14 ] observed the aforementioned angle as 65° (range, 54° to 81°), Trisolino et al[ 17 ] calculated it as 68°±11°, and Guindani et al[ 16 ] found it as 70° (range, 60° to 90°). In the current study, we demonstrated that the mean postoperative Southwick angle improved to -0.8°.…”

“…Guindani et al[ 16 ] conducted a single-center study and evaluated the three- year follow-up clinical and radiological outcomes of 23 hips with severe SCFE treated with MDO technique. Moreover, Trisolino et al[ 17 ] compared the two techniques only in severe slips and the number of patients treated with MDO was 15. With a large sample size of 28 patients, Madan et al[ 18 ] investigated the results of MDO technique in severe slips including acute cases.…”

“…Similar results were reported in the study of Novais et al[ 14 ] Guindani et al[ 16 ] calculated postoperative alpha angle as 60°. In the comparative study of Trisolino et al,[ 17 ] it was stated that patients treated with MDO procedure had a mean alpha angle of 50° whereas patients treated with in-situ fixation had a mean alpha angle of 89° postoperatively.…”

“…Guindani et al[ 16 ] revealed that eight out of 23 patients had complications, where four (17%) had AVN and implant failure, heterotrophic ossification while implant loosening constituted the rest of the complications. Trisolino et al[ 17 ] reported three cases with AVN out of 15 patients treated with MDO procedure and two of them underwent total hip replacement surgery in approximately 1.5 years. Madan et al[ 18 ] observed AVN in four patients out of 28 patients, and two of them had unstable slips and signs of AVN even in the preoperative period.…”

Outcomes of Temporary Hemiepiphyseal Stapling for Correcting Genu Valgum in Children with Multiple Osteochondromas: A Single Institution Study

“…Main analyses were performed by applying regression models on observations with complete data (complete-case analysis approach). In addition, the results’ consistency was evaluated by adjusting the comparison between the two populations by applying different propensity score approaches [ 29 ]. A p -value < 0.05 was considered statistically significant.…”