Outcomes of subcapital cuneiform osteotomy for the treatment of severe slipped capital femoral epiphysis after skeletal maturity

Abstract

We reviewed prospectively, after skeletal maturity, a series of 24 patients (25 hips) with severe acute-on-chronic slipped capital femoral epiphysis which had been treated by subcapital cuneiform osteotomy. Patients were followed up for a mean of 8 years, 3 months (2 years, 5 months to 16 years, 4 months). Bedrest with 'slings and springs' had been used for a mean of 22 days (19 to 35) in 22 patients, and bedrest alone in two, before definitive surgery. The Iowa hip score, the Harris hip score and Boyer's radiological classification for degenerative disease were used. The mean Iowa hip score at follow-up was 93.7 (69 to 100) and the mean Harris hip score 95.6 (78 to 100). Degenerative joint changes were graded as 0 in 19 hips, grade 1 in four and grade 2 in two. The rate of avascular necrosis was 12% (3 of 25) and the rate of chondrolysis was 16% (4 of 25). We conclude that after a period of bed rest with slings and springs for three weeks to gain stability, subcapital cuneiform osteotomy for severe acute-on-chronic slipped capital femoral epiphysis is a satisfactory method of treatment with an acceptable rate of complication.

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

“…A number of treatments options were reported for the study population including epiphysiodesis [10,11], pinning in situ (PIS) [1,7,[12][13][14][15][16][17][18][19], closed reduction and pinning (CRIF) [4,5,11,15,16,18,[20][21][22][23][24][25], open reduction and physeal osteotomy (PO) [1,7,15,26] open reduction and internal fixation (ORIF) [23][24][25]27] and surgical dislocation (SD) [13,15,[28][29][30].…”

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

“…4) osteotomies has been limited owing to the high rates of osteonecrosis, but this has been challenged and the outcome may simply be related to surgical experience. 46,47 The Imhäuser intertrochanteric osteotomy 48 has superseded the Southwick subtrochanteric osteotomy 49 and involves resecting a wedge of bone from the intertrochanteric region to correct the flexion, varus and external rotation deformities. The principles of both these osteotomies are similar, producing a reverse deformity distally.…”

“…Such low rates have not been reproduced, but in a series of 25 patients with SCFE treated with Fish's cuneiform osteotomy, the rates of osteonecrosis and OA were respectively 12% and 25% after a mean follow-up of more than eight years. 46 Velasco et al 47 reported the outcome for 66 hips treated with open reduction, 60 of which underwent a subcapital osteotomy as described by Dunn. At a mean followup of 16 years, the rates of osteonecrosis and OA were 11% and 40%, respectively.…”

(iv) Slipped upper femoral epiphysis

“…Other authors advise waiting for three weeks, with bed rest to allow the femoral head circulation to recover before surgery for the severe unstable slip. 10 Pinning in situ Stable or unstable slips of mild degree can be pinned in situ, and a good result is usually obtained. A single screw into the central third of the physis on AP & lateral planes is the ideal fixation.…”