Femoroacetabular impingement after slipped upper femoral epiphysis

Context:Several risk factors may cause femoroacetabular impingement (FAI). Knowledge of causation would identify patients for early intervention, prior to the development of painful intra-articular damage.Data Sources:PubMed, MEDLINE, EMBASE, and related article reference lists were screened for relevant studies published between January 2000 and December 2013.Study Selection:Inclusion criteria were (1) etiology of FAI, (2) original FAI clinical data, and (3) English language. Case reports of fewer than 3 patients were excluded.Study Design:Systematic review.Level of Evidence:Level 4.Results:In all, 754 studies were screened, with 18 meeting the eligibility criteria. There were 13 comparative observational studies and 5 case series. The studies pertained to intrinsic patient factors (n = 2), activity/developmental factors (n = 8), hip disease (n = 5), postsurgical changes (n = 2), and malunion after hip fracture (n = 1).Conclusion:A combination of intrinsic patient and developmental factors, activities involving repetitive hip motion, pediatric hip disease, and hip-related surgical procedures may contribute to the development of FAI.

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“…27 Femoral head ratio, alpha angles, and head-neck offset were all significantly increased in those hips with previous SCFE pathology.…”

Section: Resultsmentioning

confidence: 82%

The Etiology of Femoroacetabular Impingement

Chaudhry

Ayeni

2014

Sports Health: A Multidisciplinary Approach

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“…21,38 Wensaas et al . 17 depict the radiological signs of impingement more frequently and up to a statistically significant level with the patients operated by ISF versus the control group with an average follow-up of 37 years. This study also finds a correlation between the severity of the persistent deformity and the bad clinical and radiological evolution.…”

Section: Discussionmentioning

confidence: 99%

“…The preoperative radiological evaluation was realized by the same examiner (J.M), including the measurement of the fundamental angles (VCA, VCE, HTE and CC’D) and the alpha angle searching for signs of hip impingement. 10,17 The diagnosis of impingement was evoked by the presence of pain upon hip flexion, and the presence of a radiological bump or an alpha angle exceeding 55°. 18 The staging of osteoarthritis was done using the Tonnis classification.…”

Section: Methodsmentioning

confidence: 99%

Long-term evolution of slipped capital femoral epiphysis treated by in situ fixation: a 26 years follow-up of 11 hips

2014

Orthop Rev

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Slipped capital femoral epiphysis (SFCE) may lead to femoro acetabular impingement and long-term function impairment, depending on initial displacement and treatment. There are several therapeutic options which include in situ fixation (ISF). The objective of this study was to evaluate long-term functional and radiographic outcomes of patients with SFCE treated with ISF. We conducted a single-center, retrospective study evaluating the clinical and radiographic outcomes of SCFE in situ fixation with a mean follow-up of 26 years (10-47). Analysis of preoperative and last follow up radiographs was performed. The functional status of the hip was evaluated according to the Oxford hip score-12 and the radiographic osteoarthritis stage was rated according to Tönnis classification. Signs of femoro acetabular impingement were sought. Ten patients (11 hips) were included. The average initial slip was 33.5° (10-62). At final follow up, the average Oxford hip score was 19.3 (12-37), it was good for groups who had a small initial slip (16.7) or moderate (17) and fair for the severe group (27). Average Tönnis grade was 1.3 (0-3). The average alpha angle was 65.3° (50-80°). Femoro acetabular impingement was likely in 100% of patients with severe slip, in 50% of patients with moderate slip and in 33% of patients with a slight slip. In situ fixation generated poor functional results, substantial hip osteoarthritis and potential femoro acetabular impingement in moderate to severe SCFE’s. However, in cases with minor displacement, functional and radiographic results are satisfactory. The cut off seems to be around 30° slip angle, above which other treatment options should be considered.

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“…The frog-lateral (Lauenstein) pelvis projection is used for the radiologic diagnosis of FAI ( Figures 5, 6) [28]. The alpha-angle (normally <55°), the anterior head-neck offset ratio (HNOR: neck-head offset divided by the femoral head width, normally >0.15), and the anterior femoral head-neck offset (OS, normally >10mm) are useful radiologic measurements to describe an abnormal femoral head-neck junction and to establish the diagnosis of FAI on a painful post-slip hip [28]. Other x-ray views, which may be used for the radiologic assessment of FAIassociated femoral neck deformity, are the 45° Dunn view (45° hip flexion, neutral rotation, 20°a bduction) [21].…”

Section: C Femoroacetabular Impingement and Early Hip Degenerationmentioning

confidence: 99%

“…The femoral neck is shorter and thicker compared to the healthy contralateral hip. The femoral neck resembles the grip of a pistol [1,6,9,[20][21][22]24,28,31,38,39].…”

Section: B Remodeling Of the Femoral Head-neck Junctionmentioning

confidence: 99%

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

Samelis

Papagrigorakis

Konstantinou

et al. 2020

Cureus

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Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and earlyonset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.

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Femoroacetabular impingement after slipped upper femoral epiphysis

Cited by 49 publications

References 37 publications

The Etiology of Femoroacetabular Impingement

The Etiology of Femoroacetabular Impingement

Long-term evolution of slipped capital femoral epiphysis treated by in situ fixation: a 26 years follow-up of 11 hips

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis

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