Slipped capital femoral epiphysis: a review of management in the hip impingement era

Abstract

Slipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making.

Degenerative changes of the hip following in situ fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study

“…Based upon the anticipated process of bone remodelling of the metaphyseal flare, ISF of the epiphysis without reduction is a widely accepted treatment for SCFE. [8][9][10] However, if proximal femoral remodelling is not sufficient, FAI may occur and can lead to chondrolabral damage and subsequent early hip OA even in mild slips. 1,9,10 The main finding of this study is that early degenerative changes and early end-stage OA are more common in SCFE hips than in contralateral normal hips.…”

“…[8][9][10] However, if proximal femoral remodelling is not sufficient, FAI may occur and can lead to chondrolabral damage and subsequent early hip OA even in mild slips. 1,9,10 The main finding of this study is that early degenerative changes and early end-stage OA are more common in SCFE hips than in contralateral normal hips. Furthermore, this study confirms that AVN is a rare complication after ISF, limited to unstable SCFE hips, and finally that in the long term, but still at a relatively young age, a high number of patients become symptomatic and have significantly impaired functionality compared to an age-matched healthy reference population.…”

“…8,[21][22][23][24][25] An important mechanism of early joint degeneration following ISF for SCFE is the abutment of the uncovered anterior femoral neck against the acetabulum, leading to a cam-type FAI syndrome. 9,10 Agricola et al 26 demonstrated that hips with cam-type deformity and decreased internalrotation (⩽20°) are at high risk of fast progression to end stage OA. The internal hip rotation in flexion in this study was significantly lower in SCFE hips compared to contralateral normal hips (19.7° vs. 36.1°, p < 0.001), which supports the concept that degenerative changes after SCFE can be secondary to cam-impingement.…”

Tratamento artroscópico do impacto femoroacetabular na epifisiólise capital femoral proximal: Relato de caso

“…There is evidence in the literature to support arthroscopic osteochondroplasty of the femoral neck in the treatment of symptomatic FAI secondary to SCFE, with encouraging results, 6 7 and an early approach is suggested right after the slide in order to prevent irreversible progression with worse long-term results. 7 …”

“…Há evidências na literatura que apoiam a osteocondroplastia artroscópica do colo femoral no tratamento do IFA sintomático secundário a ECFP, com resultados animadores, 6 7 e é sugerida a abordagem precoce logo após o deslizamento, a fim de se prevenir contra a progressão irreversível com piores resultados em longo prazo. 7 …”