Degenerative changes of the hip following <i>in situ</i> fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study

Ghijselings, Stijn; Touquet, Jeroen; Himpe, Nicolas; Simon, Jean‐Pierre; Corten, Kristoff; Moens, Pierre

doi:10.1177/1120700019867248

Cited by 9 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The downside of in situ fixation is that even large deformations are left uncorrected overall resulting in an abutment of the anterior metaphyseal flare against the acetabular rim, causing chondrolabral damage 59 – 61 and exposing young patients to the risk of early hip dysfunction. 62 In many centres severe or unstable SCFE is nowadays treated open using surgical hip dislocation with development of a retinacular soft tissue flap to perform a subcapital re-alignment of the slipped epiphysis, the so-called ‘modified Dunn’ procedure. 63 The femoral head is stepwise mobilized respectively and separated from the femoral epiphysis.…”

Section: Slipped Capital Femoral Epiphysis (Scfe)mentioning

confidence: 99%

See 1 more Smart Citation

Hip preservation

et al. 2020

View full text Add to dashboard Cite

Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described: (1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’). Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results. Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074

show abstract

Section: Slipped Capital Femoral Epiphysis (Scfe)mentioning

confidence: 99%

“… 67 In contrast to the modified Dunn procedure, devastating long-term results were shown for in situ pinning with almost 75% of hips demonstrating degenerative changes on X-rays or requiring conversion to THA in a series with a mean follow-up of 23 years. 62 …”

Section: Slipped Capital Femoral Epiphysis (Scfe)mentioning

confidence: 99%

Hip preservation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…increases the risks of osteonecrosis, chondrolysis, and advanced hip arthritis [9][10][11][12][13][14] .…”

mentioning

confidence: 99%

“…The delay in diagnosis has critical implications for both short-term and long-term patient morbidity. Longer delay is associated with increased slip severity, which, in turn, increases the risks of osteonecrosis, chondrolysis, and advanced hip arthritis 9-14 .…”

mentioning

confidence: 99%

Public Insurance and Single-Guardian Households Are Associated with Diagnostic Delay in Slipped Capital Femoral Epiphysis

Smith,

Chang,

Feldman

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Extensive literature documents the adverse sequelae of delayed diagnosis of slipped capital femoral epiphysis (SCFE), including worsening deformity and surgical complications. Less is known about predictors of delayed diagnosis of SCFE, particularly the effects of social determinants of health. The purpose of this study was to evaluate the impact of insurance type, family structure, and neighborhood-level socioeconomic vulnerability on the delay of SCFE diagnosis. Methods: We reviewed medical records of patients who underwent surgical fixation for stable SCFE at a tertiary pediatric hospital from 2002 to 2021. We abstracted data on demographic characteristics, insurance status, family structure, home address, and symptom duration. We measured diagnostic delay in weeks from the date of symptom onset to diagnosis. We then geocoded patient addresses to determine their Census tract-level U.S. Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI), using U.S. Census and American Community Survey data. We performed 3 separate logistic regression models to examine the effects of (1) insurance status, (2) family structure, and (3) SVI on a delay of ≥12 weeks (reference, <12 weeks). We adjusted for age, sex, weight status, number of siblings, and calendar year. Results: We identified 351 patients with SCFE; 37% (129) had a diagnostic delay of ≥12 weeks. In multivariable logistic regression models, patients with public insurance were more likely to have a delay of ≥12 weeks than patients with private insurance (adjusted odds ratio [OR], 1.83 [95% confidence interval (CI), 1.12 to 2.97]; p = 0.015) and patients from single-guardian households were more likely to have a delay of ≥12 weeks than patients from multiguardian households (adjusted OR, 1.95 [95% CI, 1.11 to 3.45]; p = 0.021). We did not observe a significant increase in the odds of delay among patients in the highest quartile of overall SVI compared with patients from the lower 3 quartiles, in both the U.S. comparison (adjusted OR, 1.43 [95% CI, 0.79 to 2.58]; p = 0.24) and the Massachusetts comparison (adjusted OR, 1.45 [95% CI, 0.79 to 2.66]; p = 0.23). Conclusions: The delay in diagnosis of SCFE remains a concern, with 37% of patients with SCFE presenting with delay of ≥12 weeks. Public insurance and single-guardian households emerged as independent risk factors for diagnostic delay. Interventions to reduce delay may consider focusing on publicly insured patients and those from single-guardian households. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Patients’ delay is the major cause for late diagnosis of slipped capital femoral epiphysis

Örtegren

Österman

Tiderius

2020

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

Early diagnosis of slipped capital femoral epiphysis (SCFE) is essential in order to reduce slip severity and subsequent risk of sequelae. The aims of this study were to evaluate patients’ and doctors’ delay in SCFE diagnosis and to identify possible factors leading to delay. We performed a retrospective review of medical charts and a personal interview with 54 consecutive patients admitted with a diagnosis of stable SCFE at three hospitals in Sweden between 2001 and 2009. Data on symptom duration, symptomatology, medical visits and type of medical contacts were retrieved. Slip angle (Southwick head-shaft angle) was measured. Median total delay from onset of symptoms to surgery was 26 weeks (range 1-109). Patients’ delay was significantly longer than doctors’ delay: 10 weeks (range 1-57) vs. 4 weeks (range 0-57) (P=0.002). Boys had significantly longer patients’ delay than girls (13 vs. 6 weeks, P=0.021) but not doctors’ delay. Children with dominance of knee pain had significantly longer doctors’ delay (14 vs. 4 weeks, P=0.002) but not patients’ delay. As expected, the total delay duration correlated with slip severity (R=0.59, P<0.001). Results demonstrate considerable delay in diagnosis of SCFE in Sweden, although the major cause is patients’ delay. Boys and children with dominance of knee pain are more likely to be diagnosed late. Efforts to increase the awareness of SCFE directed to both the general society and healthcare providers are necessary to improve future outcomes. Level III. Retrospective comparative study.

show abstract

Degenerative changes of the hip following in situ fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study

Cited by 9 publications

References 26 publications

Hip preservation

Hip preservation

Public Insurance and Single-Guardian Households Are Associated with Diagnostic Delay in Slipped Capital Femoral Epiphysis

Patients’ delay is the major cause for late diagnosis of slipped capital femoral epiphysis

Contact Info

Product

Resources

About