Long-term results after nailing in situ of slipped upper femoral epiphysis: A 30-year follow-up of 59 hips

Abstract

We reviewed the radiological and clinical long-term results after the nailing in situ of slipped upper femoral epiphysis in 59 hips in 43 patients. The displacement of the epiphysis had been measured as the 'slipping angle' before operation and related to the results at follow-up at a mean of 30.9 years (27 to 34). The mean age at follow-up was 44.2 years (39 to 50). Radiographic re-examination of 41 hips with slipping angles of < or =30 degrees at the time of operation showed that eight (20%) had developed mild osteoarthritis and one had severe changes. For 18 hips with slipping angles ranging from 31 to 50 degrees at surgery six (33%) had mild osteoarthritis and three had severe changes. The differences did not quite achieve statistical significance (p = 0.09). Clinical re-examination of the 41 hips with slipping angles of < or =30 degrees showed fair or poor results (Harris hip score <90) in three (7%). In the 18 hips with slipping of 31 to 50 degrees, four had fair or poor results (22%) (p = 0.13). We conclude that nailing in situ for slipping of < or =30 degrees, using one thin nail, can give excellent long-term results. At present we recommend that hips with slips ranging from 31 to 50 degrees should also be nailed in situ, but further long-term studies are required, especially on the choice between nailing in situ and corrective osteotomy for slips in excess of 50 degrees.

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 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].…”

Devenir des épiphysiolyses fémorales supérieures après vissage in situ au recul moyen de 11 ans : à propos de 222 cas

“…Un seuil de 35 • semble se dégager au-delà duquel la survenue d'un conflit fémoro-acétabulaire serait plus fréquente. Ceci conforte les données de la littérature [7][8][9][10][11]. L'analyse de nos 222 hanches n'a permis de retrouver que 15 cas de conflit fémoro-acétabulaire et peu d'arthrose à moyen terme avec 88 % de patients qui sont cotés stade 0 ou 1 sur la classification de Tönnis.…”

(iv) Slipped upper femoral epiphysis

“…At 30 years follow up, 20% of cases with up to 30 degrees slip angle have mild osteoarthritis, 2.5% have severe arthritis. 7 Slip angles between 30 and 50 degrees lead to 33% mild osteoarthritis, and 16% severe arthritis. Results for slips more severe than 50 degrees were not recorded, and are expected to be considerably worse given that the AVN rate may exceed 50% in slips of this severity.…”