Subkapitale Korrekturosteotomie bei der Epiphyseolysis capitis femoris mittels chirurgischer Hüftluxation

Leunig, Michael; Slongo, Theddy; Kleinschmidt, Mark; Ganz, Reinhold

doi:10.1007/s00064-007-1213-7

Cited by 142 publications

(50 citation statements)

References 15 publications

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“…Some surgeons, particularly in Europe, support the role of primary osteotomy and epiphysiodesis [30][31][32][33] at the time of SCFE diagnosis. In theory, this will restore normal anatomic head-acetabular anatomy and prevent cartilage and labral damage and premature arthritis that occurs early with residual deformity.…”

Section: Femoral Osteotomiesmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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Section: Femoral Osteotomiesmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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“…Drei Patienten (11%) waren normalgewichtig (BMI 18,5-24,9), 12 (43%) präadipös (BMI [25][26][27][28][29]9), bei 5 (18%) entsprach der BMI einer Adipositas Grad I (BMI [30][31][32][33][34]9), bei 6 (21%) einer Adipositas Grad II (BMI 35-39, 9) Auf der osteotomierten Seite wurden radiologisch statistisch signifikant (p=0,016) mehr Arthrosezeichen nachgewiesen als auf der Gegenseite (. Tab.…”

Section: Ergebnisseunclassified

“…Mit der intertrochantären Osteotomie lässt sich zwar nicht immer eine vollständige Korrektur des Abrutsches erreichen [31], ein weiteres operatives Vorgehen zur Korrektur der eventuellen Restdeformität zum späteren Zeitpunkt wird jedoch nicht verhindert [32]. » Das niedrigere Risiko der Hüftkopfnekrose gilt als wichtiger Vorteil der intertrochantären gegenüber der subkapitalen Osteotomie Nachdem in den 90er Jahren der Blutversorgung des Femurkopfs mehr Beachtung gewidmet wurde [1] und schließlich eine neue Technik der subkapitalen Osteotomie mit chirurgischer Hüftluxation und Trochanterosteotomie entwickelt wurde [6,25,33], konnte auch bei diesen Versorgungen das Risiko der Hüftkopfnekrose deutlich gesenkt werden [33]. Die abgerutschte Epiphyse kann bei dieser Technik direkt anatomisch korrekt reponiert werden.…”

Section: Introductionunclassified

Langzeitergebnisse der Imhäuser-Osteotomie bei Epiphyseolysis capitis femoris lenta

et al. 2012

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“…The realignment procedures at the level of the deformity (i.e., subcapital level) can result in anatomic or near anatomic restoration of the proximal femur. As such, it is believed they offer the best chance of correcting the anatomic deformities that can lead to early osteoarthritis [20] . To reduce the risk for osteonecrosis of the epiphysis during capital reorientation, tension of the posterosuperior retinaculum, containing the end branches of the medial femoral circumflex artery is markedly reduced by wedge resection of varying size and location [21] .…”

Section: Introductionmentioning

confidence: 99%