Long-term outcome of slipped capital femoral epiphysis: A 38-year follow-up of 66 patients

Abstract

PurposeThe purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated.MethodsSixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg epiphysiodesis (30 hips), and bone-peg epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA).ResultsIn 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg epiphysiodesis. Eight patients with large chronic slip (mean slip angle 53°) were treated with bone-peg epiphysiodesis and corrective femoral osteotomy, and the clinical outcome was poor in six patients. Seven patients with acute slip had larger mean slip angle (57°) and more complications than those with chronic slip, and the long-term outcome was poor in all. Two hips out of 42 (5%) had OA in the contralateral hip at follow-up.ConclusionIn situ fixation of chronic SCFE gave satisfactory long-term outcome irrespective of the treatment method. Corrective femoral osteotomy did not improve the outcome in hips with large slip angles. Acute SCFE had poor outcome. Prophylactic fixation of the contralateral hip is barely necessary.

Case Reports: Acetabular Damage After Mild Slipped Capital Femoral Epiphysis

“…Long-term outcome studies after SCFE are compromised by heterogeneity in the modes of treatment, variation in functional scoring, and inconsistency in the radiographic methods used to grade epiphyseal displacement and OA [4,5,13,14,37]. Rates of radiographic OA range from 24% at 28 years' followup [13] to as high as 92% at 11 years' followup [41], depending on how OA is defined.…”

“…Rates of radiographic OA range from 24% at 28 years' followup [13] to as high as 92% at 11 years' followup [41], depending on how OA is defined. Rates of conversion to arthrodesis or arthroplasty vary from 4.5% at 16 years' followup [17] to 22% at 38 years' followup [37]. Long-term reports cite good functional outcomes by the Iowa hip score [5] or Harris hip score [14,17,37,41].…”

“…Rates of conversion to arthrodesis or arthroplasty vary from 4.5% at 16 years' followup [17] to 22% at 38 years' followup [37]. Long-term reports cite good functional outcomes by the Iowa hip score [5] or Harris hip score [14,17,37,41]. However, there is a ceiling effect when applying instruments that were validated in patients with arthritis and arthroplasty to a younger population [17].…”

“…femoroacetabular impingement (FAI). Because reduction of the slip has been associated with an increased risk of osteonecrosis and arthrosis [5,13] and the head-neck deformity has been observed to remodel over time [3,4,6,8,15,16,29,39], the recommended treatment for SCFE has traditionally been in situ fixation [4,5,[13][14][15]37].…”

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

“…Volume 471, Number 7, July 2013 Obesity and SCFE: A Call for Action 2141 option would introduce a midline approach, avoid the surgical prophylactic pinning of the contralateral hip in willing patients with UL-SCFE, and its possible iatrogenic risks yet closely monitoring patients and actively reducing the risks for potential sequelae of a SCFE, particularly an unstable or severe SCFE that might occur in an unpinned contralateral hip [9,42,47]. Hence, the present study aimed first to evaluate obesity and other clinical features as potential risk factors for BL-SCFE and then to investigate the association between sufficient increase or decrease in BMI percentile to move from being obese to nonobese or vice versa in the postoperative period after surgical treatment of UL-SCFE and the impact this change could have on the relative risk for BL-SCFE.…”