Femoral Morphology Due to Impingement Influences the Range of Motion in Slipped Capital Femoral Epiphysis

Mamisch, T.C.; Kim, Young-Jo; Richolt, Jens A.; Millis, Michael B.; Kordelle, J.

doi:10.1007/s11999-008-0477-z

Cited by 97 publications

(87 citation statements)

References 21 publications

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“…unaffected hips and 11.9°to 15.7°for affected hips; these results are similar to ours [16,23,34]. Consistent with previous literature, our study did not demonstrate any difference in AV cen among affected hips, unaffected hips, and the normal control group, suggesting the retroversion found in AV sup is localized to the superior part of the acetabulum.…”

supporting

confidence: 92%

“…In contrast to Sankar et al [30], who used biplanar radiography and the crossover sign [29] to demonstrate acetabular retroversion, previous studies finding no relationship between acetabular retroversion and SCFE utilized two-dimensional (2-D) and three-dimensional (3-D) CT [16,23,34]. These CT-based studies evaluated acetabular retroversion based on only a single axial slice corresponding to the center of the femoral head.…”

Section: Introductionmentioning

confidence: 99%

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Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Monazzam

Venkatadass

Bittersohl

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Recent biplanar radiographic studies have demonstrated acetabular retroversion and increased superolateral femoral head coverage in hips with slipped capital femoral epiphysis (SCFE), seemingly divergent from earlier CT-based studies suggesting normal acetabular version. Question/purposes We therefore asked: Are there differences in (1) acetabular version at the superior 1 .4 of the acetabular dome (AV sup ), (2) acetabular version at the center of the femoral head (AV cen ), and (3) superolateral femoral head coverage (lateral center-edge angle [LCEA]) among affected SCFE hips, unaffected hips, and normal controls? Methods We identified 32 patients with SCFE who underwent CT between 2007 and 2012. Twenty-three met our inclusion criteria. Seventy-six age-and sex-matched normal patients comprised the control group. Pelvic rotation, tilt, and inclination were corrected on each CT. AV sup , AV cen , and LCEA were measured. Results The mean AV sup of the affected hips (À1.71°) demonstrated retroversion compared to the unaffected hips and the control group; the mean AV sup of the unaffected hips was similar to that of the normal controls. Mean AV cen was similar among the three groups. The LCEA was higher in affected and unaffected SCFE hips than in the control group (34.3°versus 34.5°versus 28.9°, respectively), but we found no difference between affected and unaffected hips. Conclusions Our data suggest an association of superior acetabular retroversion and increased superolateral femoral head coverage in SCFE. Whether this represents a primary abnormal morphology or a secondary pathologic response remains unclear. Further studies investigating the role of acetabular morphology in SCFE and its implications for development of symptomatic femoroacetabular impingement are warranted.

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supporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Monazzam

Venkatadass

Bittersohl

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The posterior wall sign was positive in 85 % of cases [26]. This is in contrast to Mamisch et al and Kordelle et al [27,28], who, in two separate studies, found no relationships between acetabular version and SCFE. Controversy remains concerning the existence of abnormal acetabular morphology in SCFE and whether it is a primary or secondary phenomenon.…”

Section: Bony Impingement-pathologymentioning

confidence: 95%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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“…The remodeling process has been associated with 39% excellent and 50% good results assessed by the Heyman and Herndon criteria in a series of 44 patients followed for an average of 11.4 years [7]. Current investigations however have challenged remodeling as a benign process [42,54,69]. Using a three-dimensional modeling study, Rab [69] described two types of mechanical conflict between the femoral metaphysis and the acetabulum in the production of abnormal motion after SCFE.…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

Novais

Millis

2012

Clinical Orthopaedics &Amp; Related Research

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135

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Background Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term. Questions/Purposes We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment. Methods A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively. Where Are We Now? A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE. Where Do We Need to Go? Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes. How Do We Get There? Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.

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Femoral Morphology Due to Impingement Influences the Range of Motion in Slipped Capital Femoral Epiphysis

Cited by 97 publications

References 21 publications

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

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