High Survivorship and Little Osteoarthritis at 10-year Followup in SCFE Patients Treated With a Modified Dunn Procedure

Ziebarth, Kai; Milošević, Milan; Lerch, Till; Steppacher, Simon D.; Slongo, Theddy; Siebenrock, Klaus A.

doi:10.1007/s11999-017-5252-6

Cited by 63 publications

(57 citation statements)

References 76 publications

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“…26 Ziebarth et al had no complications, 2 and at 12 years follow-up they found in 42 patients no AVN and an 9% overall complication rate, though secondary impingement deformi-ties remained in some patients, and secondary surgical procedures undergoing open procedures for impingement deformities (14%). 27 Huber et al 28 found 5 out of 28 patients (18%) with overall complications and 1 (3%) AVN; Madan et al 29 reported 5 out of 28 patients (18%) with overall complications and 4 (14%) AVN, Sankar et al 30 reported 41% with overall complications and 7 out of 27 patients (26%) AVN, and Upasani et al 7 reported 16 out of 43 patients (37%) with overall complications and 10 (23%) AVN. Except the Bernese group, the others had similar complication rates and this is carefully to be considered when approaching this technique.…”

Section: Discussionmentioning

confidence: 99%

“…33 Ziebarth et al recently described a high survival rate at 12 years, probably the longest follow-up available. 27 In this prospect, a longterm analysis is imperative, as the results of MDO must be compared with the natural history of SCFE and with other available techniques. According to medium-/short-term results and overall complication rates, we consider the subcapital osteotomy suitable only for specialized centers, performed by experienced high-volume surgeons and for severe displaced SCFE (!50°).…”

Section: Discussionmentioning

confidence: 99%

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The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

et al. 2017

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The modified Dunn osteotomy (MDO) gained popularity for the treatment of moderate-to-severe SCFE over the past years, even though both indications and outcomes are currently debated. The aim of this study is to evaluate results and complications of MDO consecutively performed at a single institution for severe slipped capital femoral epiphysis (SCFE) (slip angle ≥ 60°). In this retrospective clinical study, 23 hips (22 patients) were treated with MDO (2009–2015). SCFE was classified according to stability, slip angle, and as chronic/acute. Clinical assessment was performed with clinical examination and nonarthritic hip score (NAHS), modified Harris hip score (mHHS), and short form 12 (SF-12) outcome scores. Residual deformity, avascular necrosis (AVN), and osteoarthrosis (OA) were measured on plain radiographs. The mean slip angle was 70° (range 60–90); 17 of 23(74%) patients had a chronic SCFE, 6 of 23(26%) had acute-on-chronic SCFE, and 1 of 23(4%) had an unstable SCFE. The mean age at surgery was 14 years (range 11–17). At 3 years follow-up (range 1–7), 4 of 23(17%) patients had an AVN or AVN progression, one of these needing a hip arthroplasty. All the cases of AVN or AVN progression were diagnosed within the first year after surgery and there was an association between AVN and operation date (with more AVN among patients operated earlier). Out of 23 patients, 2 (9%) had an implant mobilization or failure and needed a revision surgery without further complications, 1 (4%) developed an asymptomatic heterotopic calcification, and another a partial implant removal without clinical consequence. At follow-up, the slip angle was 9° (range 1–15) and outcome scores were improved. MDO is a demanding technique which allows a near anatomical correction of SCFE and the overall complication rate is not negligible. With actual data, the authors only recommend this procedure for specialized centers, performed by experienced high-volume surgeons, and for severe displaced SCFE (≥50°). The long-term results must be closely monitored and compared with the natural history and other treatment options. This study was a Level IV retrospective study in a case series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

et al. 2017

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“…The epiphysis is then manually reduced on the metaphyseal stump and fixed with anterograde Kirschner wires. 63 Of the hips, 93% presented with no progression of osteoarthritis, good clinical scores and no subsequent total hip arthroplasty (THA) at 10-year follow-up 64 following a modified Dunn procedure. Different rates of avascular necrosis (AVN) are reported for the modified Dunn procedure in the literature with low rates of 4–6% 65 , 66 or high rates of up to 26%.…”

Section: Slipped Capital Femoral Epiphysis (Scfe)mentioning

confidence: 99%

Hip preservation

et al. 2020

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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

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“…Незначительное Показания и противопоказания к модифицированной операции Dunn, которых мы придерживались в своей работе, как и примененная нами техника вмешательства, полностью согласуются с данными литературы [20][21][22]. Между тем в отли чие от большинства авторов [23][24][25][26] у нас отсутствует опыт выполнения этой операции при ЮЭГБК со смещением эпифиза средней степени тяжести. Клинико-рентгенологическая характеристика наших пациентов в рассматриваемые сроки послеоперационного периода, как и количество ранних осложнений хирургического лечения, также соответствуют литературным данным [27][28][29].…”

Section: результаты и их обсуждениеunclassified

Our experience of the modified Dunn procedure in children with slipped capital femoral epiphysis (preliminary results)

Barsukov

Борисович²,

Баиндурашвили

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Backgrоund. The spatial correlations of the epiphysis and acetabulum during slipped capital femoral epiphysis (SCFE) with acute (at the stage of partial synostosis) and chronic displacement of the epiphysis to a severe degree were restored using different extra-articular corrective hip osteotomy techniques and the standard Dunn procedure. A large number of postoperative ischemic complications and/or the remaining residual displacement of the epiphysis, which is the cause of FAI, was the rationale for improving traditional surgical methods. In 2007, a modified technique of the classic Dunn procedure was proposed using a low traumatic surgical hip dislocation. Aim. The aim of the study was to evaluate the effectiveness of the modified Dunn procedure in the treatment of children with SCFE. Materials and methods. The data of preoperative and postoperative clinical and radiological studies of 10 patients (six males and four females) aged 1115 years who were suffering from SCFE with severe epiphyseal displacement were analyzed. In five cases, the displacement of the epiphysis was chronic, in four cases it was acute associated with chronic, and in one case it was primarily acute. In the joints with acute displacement at the time of surgery, there were signs of partial synostosis at the level of the epiphyseal growth plate. All children underwent a modified Dunn procedure with strict adherence to the authors technique. The maximum follow-up period was 1.5 years. Results. Evaluation of the most short-term anatomical and functional treatment results confirmed a satisfactory result in half (5/10) of the observations with the possibility of an additional three. In two cases, a poor treatment result was obtained due to the development of an early complication in the form of aseptic necrosis of the femoral head. The number of early complications of surgical treatment that were recorded is consistent with the literature. Conclusions. To date, the modified Dunn procedure is the only intervention with a relatively small number of complications that provides a complete and accurate reposition of the epiphysis, thereby eliminating FAI in the above anatomical situations. The modified Dunn procedure can be characterized as an effective intervention for SCFE with severe, acute (at the stage of partial synostosis), and chronic displacements of the epiphysis. The authors intend to continue using the procedure in practice.

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High Survivorship and Little Osteoarthritis at 10-year Followup in SCFE Patients Treated With a Modified Dunn Procedure

Abstract: Level IV, therapeutic study.

Cited by 63 publications

References 76 publications

The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

The Modified Dunn Osteotomy for SCFE: Clinical and Radiographical Results at 3 Years Follow-Up

Hip preservation

Our experience of the modified Dunn procedure in children with slipped capital femoral epiphysis (preliminary results)

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