Hip morphology in slipped capital femoral epiphysis

Galletta, Claudia; Aprato, Alessandro; Giachino, Matteo; Boero, Silvio; Turchetto, Luigino; Massè, Alessandro

doi:10.1097/bpb.0000000000000807

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…Sankar et al 11 found a relationship between acetabular retroversion and SUFE using the radiological COS and PWS, with more recent studies showing an increased incidence of the same signs when compared to a matched control population. 38 …”

Section: Discussionmentioning

confidence: 99%

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

et al. 2022

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Aims Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Hips with dysplasia, osteoarthritis, and Perthes’ disease, however, have higher rates, ranging from 18% to 48%. The aim of our study was to assess the prevalence of acetabular retroversion in patients presenting with SUFE using both validated radiological signs and tomographical measurements. Methods A retrospective review of all SUFE surgical cases presenting to the Royal Children’s Hospital, Melbourne, Australia, from 2012 to 2019 were evaluated. Preoperative plain radiographs were assessed for slip angle, validated radiological signs of retroversion, and standardized postoperative CT scans were used to assess cranial and mid-acetabular version. Results In all, 116 SUFEs presented in 107 patients who underwent surgical intervention; 47 (52%) were male, with a mean age of 12.7 years (7.5 to 16.6). Complete radiological data was available for 91 patients (99 hips) with adequate axial CT imaging of both hips. Overall, 82 patients (82%) underwent pinning in situ (PIS), with subcapital realignment surgery (SRS) performed in 17 patients (18%) (slip angles > 75°). Contralateral prophylactic PIS was performed in 72 patients (87%). On the slip side, 62 patients (68%) had one or more radiological sign of retroversion. Tomographical acetabular retroversion was more pronounced cranially than caudally of the acetabulum on both the affected side and the contralateral side (p < 0.001) as expected in the normal population. Increasing severity of the slip was found to be directly proportional to the degree of reduction in cranial and central acetabular version (p < 0.05) in the SUFE hips. Conclusion Acetabular retroversion is more prevalent in patients with SUFE than previously reported, and have been shown be correlated to the severity of the slip presentation. The presence of radiological signs of acetabular retroversion could be used to justify prophylactic contralateral pinning. Cite this article: Bone Jt Open 2022;3(2):158–164.

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Section: Discussionmentioning

confidence: 99%

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

et al. 2022

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“…Slipped Capital Femoral Epiphysis (SCFE) is a pathology developing during the pubertal growth spurt [3] presenting with a broad spectrum of severity [1]. Accordingly treatment has to be individualized [2]. The goal of treatment is to prevent secondary coxarthrosis, which in mild slips is best achieved by in-situ pinning to prevent further increase of displacement [19], combination with Imhäuser-Southwick intertrochanteric osteotomy on more severe slips [4], or direct reduction of the slipped epiphysis to restore anatomy as first described by DUNN [1].…”

Section: Introductionmentioning

confidence: 99%

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Romanyshyn,

Schchurovsky,

Ulrich Exner

2024

OTP

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Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

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Causes of total hip replacement in children: part 1

Bortulev,

Vissarionov,

Baindurashvili

et al. 2024

Traumatology and Orthopedics of Russia

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Background. Total hip arthroplasty (THA) is one of the most frequently performed and effective surgical procedures in patients with hip osteoarthritis of various origin. According to a variety of large arthroplasty registries, in 10-33% of cases, the causes of end-stage hip osteoarthritis in people under the age of 25 are such orthopedic diseases of the hip as dysplasia, SCFE and Perthes disease. However, there are practically no scientific publications examining the causes of the development of end-stage hip osteoarthritis in patients under the age of 21, as well as in children, in the foreign literature and there are none at all in the domestic literature. The aim of the study is to analyze the causes of the development of end-stage hip osteoarthritis requiring total hip arthropasty in children who had suffered major orthopedic diseases of the hip. Methods. The retrospective study is based on the medical records of 500 patients (530 hip joints) aged between 10 and 18 years (15.1±1.5) who had underwent total hip replacement at the Department of Hip Pathology of the G.I. Turner National Research Medical Center for Pediatric Traumatology and Orthopedics, in the period from 2008 to 2023. The main subject of the study was the anamnesis of the course of the orthopedic disease and previous treatment. Results. After studying the medical records and archival X-rays, we have identified the main diagnostic and tactical errors in the treatment of patients with major diseases of the hip, which are specific to childhood. Additionally, according to these nosological entities we have identified the most “endemic” federal regions and subjects of the Russian Federation. Conclusions. The main causes of the development of end-stage hip osteoarthritis requiring total hip arthroplasty in patients under the age of 18 with major orthopedic diseases of the hip are: diagnostic defects, methodological choice of both conservative and surgical treatment, and iatrogenic damage to the joint components.

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Hip morphology in slipped capital femoral epiphysis

Cited by 3 publications

References 31 publications

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Causes of total hip replacement in children: part 1

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