Prognostic factors for long-term outcome of chronic slipped capital femoral epiphysis treated with fixation in situ

Abstract

PurposePredictive factors for long-term outcome after in situ fixation for chronic slipped capital femoral epiphysis (SCFE) have so far not been systematically analysed. The aims of this study were to define predictors for long-term outcome and to assess the association between initial grade of slipping and post-slip deformities.MethodsWe studied 51 patients (60 hips) with chronic SCFE treated with in situ fixation. There were 31 males and 20 females with a mean age of 12.9 years. The mean follow-up was 39.0 years (21.1 to 56.8). Post-slip deformity was defined as abnormal alpha (a) angles in anteroposterior (AP) and lateral radiographs; AP angle of 74° and lateral angle of 63° were used as cutoffs between normal and abnormal α-angles. Harris hip score (HHS) less than 85 points was classified as a poor clinical outcome and osteoarthritis was a poor radiographic outcome.ResultsThe mean slip angle was 31.7° (12° to 77°). The mean AP α-angle was 67.4° (36° to 111°) and the mean lateral α-angle was 57.1° (22° to 104°). Post-slip deformities developed in almost one-third of hips with a mild degree of slipping and in about half the hips with more pronounced degrees of slipping. The long-term outcome was good in 40 hips (67%) and poor in 20 hips. A small AP α-angle was the only independent prognostic factor for a good combined clinical and radiographic outcome.ConclusionPost-slip deformity, defined as an abnormally high AP α-angle, is the most important prognostic factor for poor long-term clinical and radiographic outcome in chronic SCFE treated with in situ fixation.

Persisting CAM deformity is associated with early cartilage degeneration after Slipped Capital Femoral Epiphysis: 11-year follow-up including dGEMRIC

“…In recent years, an increased interest in FAI and its relation to OA has evolved 8,9,26,27 . Several studies have shown that SCFE is associated with an increased prevalence of FAI 28,29 . In SCFE the CAM deformity may occur already at the time for the initial slip due to the fact that the proximal femur usually slides anteriorly in relation to the epiphysis.…”

Increased body mass index percentile is associated with decreased epiphyseal tubercle size in asymptomatic children and adolescents with healthy hips

“…10–15 There is growing evidence suggesting that the epiphyseal tubercle serves as a pivot point for rotation of the metaphysis in SCFE. 16–18 As childhood obesity has been shown to affect the structure of the femur, including reduced femoral anteversion and a more posteriorly tilted epiphysis, higher BMI may be associated with variations of the capital femoral epiphysis surface that reduce physeal stability and predispose to a slip. To the best of our knowledge, information about the impact of obesity on capital femoral epiphysis morphology is lacking.…”

Good inter- and intraobserver reliability for assessment of the slip angle in 77 hip radiographs of children with a slipped capital femoral epiphysis

“… 2004 , Larson et al. 2010 , Terjesen and Wensaas 2017 ) depend on the severity of the slip. The reliability of the methods used to measure the slip angle is therefore important.…”