Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation

Abstract

Background: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater than 12–14.5° has been proposed by various authors as a treatment threshold to predict for contralateral hip progression and prophylactic pinning. Methods: A retrospective review of a 10-year series of patients with the diagnosis of SCFE and follow-up of 18 months was conducted. Patients were divided into two groups, those with Isolated Unilateral Slips and those who subsequently underwent Subsequent Contralateral Progression. PSA measurements were performed by two clinicians and assessed for inter-observer reliability. Data collected included age, sex, ethnicity, Loder class, endocrinopathy, renal impairment, radiation exposure, and PSA. Results: There were no significant differences between the distribution of gender, site of slip, age of onset, Loder class, and presence of medical comorbidities between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups ( p > 0.05). The mean PSA value was not significantly higher in the Subsequent Contralateral Progression group (17.9 ± 4.32 (10.5–23.5)) compared to the Isolated Unilateral Slip group (15.8 ± 5.31 (6–26)) ( p = 0.32). The receiver operator coefficient-derived ideal treatment threshold of 16.5° gave a sensitivity of 0.71, specificity of 0.64, and number needed to treat of 3. Conclusion: PSA differences between the Subsequent Contralateral Progression and Isolated Unilateral Slip groups were not statistically significant in this series. All proposed treatment thresholds had poor specificity. Prophylactic pinning should not be based on isolated PSA values. Level of evidence: III.

Can we still use X-rays to predict contralateral slip in primary unilateral slipped capital femoral epiphysis?

“…Our study suggests that PSA might be used as the additional quantitative parameter in decision-making in patients presenting with primary unilateral SCFE, but should not serve as the only guide to rely on. That matches the findings presented in a study by Ou Yang, who also observed slightly higher values of PSA in isolated unilateral slip (15.8 o ) vs. subsequent contralateral progression (17.9 o ) but did not prove significant differences between the groups [26,27].…”

Femoroacetabular impingement in the unpinned contralateral hip in patients with primary unilateral slipped capital femoral epiphysis: preliminary radiographic outcomes

“…Interestingly enough, the initial PSA in the contralateral hip was not significantly different between the four groups of patients assessed in this study. Similar findings were published by Ou Yang et al ., [25] who also did not find significant differences in PSA between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups. In our study, more than 70% of patients eventually developed CAM-type FAI.…”