Slipped capital femoral epiphysis management and the arthroscope

Accadbled, Franck; May, O.; Thévenin-Lemoine, Camille; Js, de Gauzy

doi:10.1302/1863-2548-11-160281

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Recent studies have reported encouraging outcomes of contemporary surgical approaches including hip arthroscopy 18–20,27–29,37 and SHD 6,21–26 but limited comparative data is available. Our findings demonstrated that symptomatic improvement can be achieved after arthroscopy for mild deformity and after surgical dislocation with or without an osteotomy for moderate and severe deformities.…”

Section: Discussionmentioning

confidence: 99%

“…17 Contemporary techniques include osteochondroplasty through an arthroscopic approach 18–20 or through a surgical hip dislocation (SHD) approach with or without a combined proximal femoral osteotomy. 21,22 Prior studies looking at the outcome of deformity correction after SCFE consist of case series of both open 6,21–26 and arthroscopic techniques 19,20,27–29 with relatively good outcomes reported for both. However, there are limited comparative studies 30 and the treatment of symptomatic FAI secondary to healed SCFE remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: A comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy

Wylie

McClincy

Uppal

et al. 2020

Journal of Children's Orthopaedics

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Purpose Our primary research question was to investigate the severity of deformity and articular damage as well as outcomes in patients undergoing hip arthroscopy compared with open surgery for the treatment of symptomatic slipped capital femoral epiphysis (SCFE) deformity. Methods Retrospective review of surgical treatment of symptomatic SCFE deformity with a minimum one-year follow-up. Patients were divided into three groups: the arthroscopic group, surgical hip dislocation(SHD) group and SHD with femoral osteotomy (SHD+ITO) group. Deformity severity was quantified. Hip outcome was assessed by the modified Merle d’Aubigné Postel (MDP) scores. Results There were more severe slips treated by SHD and SHD+ITO. There was more severe deformity in the SHD+ITO group than the arthroscopy group (p < 0.001). There were more full thickness acetabular cartilage defects in the SHD and the SHD+ITO groups (> 40%) compared with the arthroscopy group (11%; p = 0.03). The SHD+ITO and SHD group had lower MDP scores compared with the arthroscopy group both before and after surgery but no difference was detected in the amount of improvement from surgery across groups (p > 0.05). Moderate and severe SCFEs had worse preoperative scores but improvement was not different compared with mild SCFEs (p > 0.05). Conclusion Patients undergoing open treatment had more severe SCFE deformity with more extensive articular damage at reconstructive surgery compared with patients undergoing arthroscopy. All groups with SCFE deformity had improved pain and hip function postoperatively. Level of Evidence III

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: A comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy

Wylie

McClincy

Uppal

et al. 2020

Journal of Children's Orthopaedics

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“…Osteochondroplasty can be performed arthroscopically with a drill or by limited anterior arthrotomy using a modified Smith-Peterson approach. [9][10][11][12] After surgery, patients have to relieve the affected limb for 6-12 weeks using crutches or walkers. This allows you to maintain the treatment result and achieve proper union.…”

Section: Diagnosticsmentioning

confidence: 99%

Slipped Capital Femoral Epiphysis (SCFE) - diagnosis and treatment

Magdalena

Joanna

et al. 2023

J Educ Health Sport

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Background Slipped Capital Femoral Epiphysis is the most common pathology of the hip joint in preschool children and adolescents consisting of migration of the proximal femoral epiphysis, posteriorly and inferiorly, to the metaphysis (neck of the femur), which occurs through the epiphyseal (growth) cartilage. SCFE occurs with a frequency of 0.33 per 100,000 to 24.58 per 100,000 children aged 8–15 years. Purpouse The aim of the article is to characterize the disease which is SCFE, draw attention to its etiology, diagnostic and therapeutic possibilities. Materials and methods The article was based on scientific publications in the Pubmed database. The database was searched on 12 February 2023 using the phrases 'SCFE', 'Slipped Capital Femoral Epiphysis'. After reading the titles of found articles, 23 publications were selected. After the pre-analysis of the abstracts, 15 full-text works were selected to prepare the article. Results Most SCFE is idiopathic. The relationship between the development of SCFE and endocrine disorders, renal dysfunction and Down syndrome has been noted. The displacement is presumed to be caused by the application of a large axial load to the relatively fragile growth plate. Symptoms of the disease may include atraumatic pain in the hip, thigh or knee, especially if accompanied by a limp or inability to support weight. The first imaging test performed is a radiograph. If radiographs do not show changes consistent with SCFE but clinical suspicion is high, the physician may consider magnetic resonance imaging (MRI) for further evaluation. The goal of treating the lesions is to prevent further scaling of the head and to correct the deformity and to avoid osteonecrosis and chondrolysis, so various surgical procedures are used. Conclusions SCFE is an insidious disease that should always be ruled out in the diagnosis of hip pain in children. Its early treatment prevents later complications.

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“…Likewise, patients with mild, stable slips may present years after SCFE onset, without previously seeking treatment. Osteochondroplasty through controlled surgical hip dislocation, as originally described by Ziebarth et al [33], has been found in short-term follow-up studies to improve joint mobility, hip pain, and radiographic alpha angles in patients with FAI who have a history of SCFE [2,30]. One major advantage of this approach is that intertrochanteric osteotomy may be performed concomitantly, if necessary.…”

Section: Introductionmentioning

confidence: 99%

Does a History of Slipped Capital Femoral Epiphysis in Patients Undergoing Femoroacetabular Osteoplasty for Femoroacetabular Impingement Affect Outcomes Scores or Risk of Reoperation?

Sutton

Yacovelli

Vahedi

et al. 2020

Clin Orthop Relat Res

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Background Femoroacetabular impingement (FAI) can occur after slipped capital femoral epiphysis (SCFE) regardless of slip severity and even after in situ pinning. These patients represent a rare and unique demographic that is largely unreported on. It is important to further characterize the clinical presentation of these patients, associated treatment modalities, and the efficacy of these treatment modalities. Questions/purposes (1) How do patients with post-SCFE FAI typically present in terms of radiographic and surgical findings? (2) How do their hip-specific and general-health outcomes scores after mini-open femoroacetabular osteoplasty compare with those obtained in a matched group of patients with FAI caused by other etiologies? (3) How do those groups compare in terms of the proportion who undergo conversion to THA? Methods Between 2013 and 2017, 20 patients had femoroacetabular osteoplasty for post-SCFE FAI. During that time, general indications for this procedure were symptomatic FAI demonstrated on radiographs and physical exam. Of those, none was lost to follow-up before a minimum of 2 years, leaving all 20 available for matching, and all 20 had suitable matches in our database for patients who underwent femoroacetabular osteoplasty for other diagnoses. Matching was performed by surgeon, patient age, patient gender, and BMI. The matching group was drawn from a large database of patients who had the same procedure during the same period. We matched in a 1:3 ratio to arrive at 60 randomly selected control patients in this retrospective, comparative study. Patient demographics, medical history, clinical presentation, radiographic parameters, and intraoperative findings were compared between the two groups. At a minimum of 2 years of follow-up, the latest clinical functional outcome scores (Hip Disability and Osteoarthritis Outcome Score Jr and SF-12) and proportions of conversion to THA were compared between the groups. Results A greater percentage of patients with a history of SCFE than those without prior SCFE demonstrated full chondral lesions intraoperatively (90% [18 of 20] versus 32% [19 of 60], odds ratio 7 [95% confidence interval 1 to 178]; p < 0.01). A greater percentage of patients with a history of SCFE also demonstrated labral calcifications intraoperatively compared with those without prior SCFE (65% [13 of 20] versus 35% [21 of 60], OR 3 [95% CI 1 to 10]; p = 0.04). Radiographically, patients with SCFE had greater preoperative alpha angles than did patients without SCFE (94° ± 13° versus 72° ± 22°; p = 0.01) as well as lower lateral center-edge angles (25° ± 8° versus 31° ± 8°; p = 0.04). There was no difference in postoperative follow-up between patients with a history of SCFE and patients without a history of SCFE (4 ± 2 years versus 4 ± 2 years; p = 0.32). There was no difference in the mean postoperative outcome scores between patients with a history of SCFE and patients without (Hip Disability and Osteoarthritis Outcome Score Jr: 75 ± 28 points versus 74 ± 17 points; p = 0.95; SF-12 physical score: 40 ± 11 points versus 39 ± 8 points; p = 0.79). There was no difference with the numbers available in the percentage of patients who underwent conversion to THA (15% [3 of 20] versus 12% [7 of 60], OR 1.36 [95% CI 0 to 6]; p = 0.71). Conclusion Patients with FAI after SCFE present with a greater degree of labral and chondral disease than do patients without a history of SCFE. However, at short-term follow-up, the proportion of patients who underwent conversion to THA and patients’ postoperative outcome scores did not differ in this small, comparative series between patients with and without SCFE. Further evaluation with long-term follow-up is needed, especially given the more severe chondral damage we observed in patients with SCFE at the time of surgery. Level of Evidence Level III, therapeutic study.

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Slipped capital femoral epiphysis management and the arthroscope

Cited by 6 publications

References 10 publications

Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: A comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy

Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: A comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy

Slipped Capital Femoral Epiphysis (SCFE) - diagnosis and treatment

Does a History of Slipped Capital Femoral Epiphysis in Patients Undergoing Femoroacetabular Osteoplasty for Femoroacetabular Impingement Affect Outcomes Scores or Risk of Reoperation?

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