Surgical Hip Dislocation for Anatomic Reorientation of Slipped Capital Femoral Epiphysis: Preliminary Results

Abstract

Controversies exist regarding the best treatment for slipped capital femoral epiphysis (SCFE). Subcapital anatomical reorientation of the epiphysis by surgical dislocation and a retinacular soft tissue flap has been described recently as an effective approach. We evaluated the clinical and radiographic efficacy of this technique and compared these to published results. A series of 20 SCFE (18 stable, 2 unstable) treated by subcapital re-orientation through surgical hip dislocation and an extended retinacular soft tissue flap was reviewed retrospectively. Preoperatively and at most recent follow-up, patients were clinically examined with regard to pain and function according to the Harris hip score and to the Western Ontario and McMaster universities (WOMAC) score. Radiological examination included measurement of preoperative and postoperative anteroposterior (AP) and lateral (L) Southwick angles; and at follow-up the alpha angle was measured. The average follow-up time was 24 months. The mean WOMAC score was 2.80 post-operatively. The mean pre-operative slip angle was 40.2 degrees on the AP view and 50.65 degrees on the lateral view. Post-operatively, the mean values were 7,20 degrees on the AP view and 9,45 degrees on the lateral view. The mean post-operative average alpha angle was 43,11 degrees. No cases of avascular necrosis were seen. Our short term clinical and radiographic results are similar to outcomes published in the recent literature. The small number of technical complications appears favourable considering the surgical complexity of the procedure, and our technique offers clear advantages in treating these complex deformities.

Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE

“…Despite historically better long-term outcomes after in situ pinning compared with reorientation procedures for mild and moderate SCFE, the residual deformity in severe SCFE is recognized to negatively affect its prognosis [7,8]. The modified Dunn subcapital realignment procedure using a surgical hip dislocation approach has been reported to provide restoration of the femoral head-neck anatomy with low rates of osteonecrosis for treatment of stable SCFE [17,24,26,33,39]. Despite the reported low rates of osteonecrosis, the modified Dunn technique may have a higher risk when compared with in situ pinning.…”

“…The modified Dunn procedure has been reported to allow for full restoration of femoral epiphyseometaphyseal alignment although it is a more technically demanding surgical procedure [17,24,26,33,39]. At our institution, since 2007 the modified Dunn procedure has been gradually favored for treatment of moderate and severe SCFE.…”

“…Advancements in the understanding of the blood supply to the femoral head [15] and in the technique for safe dissection of the posterior retinaculum containing the nutrient vessels to the femoral head [13] have allowed for development of a modified Dunn subcapital realignment procedure using the surgical hip dislocation approach [24]. Encouraging results with complete restoration of proximal femoral anatomy and low rates of osteonecrosis for stable SCFE have been reported [17,24,26,33,39]. Nevertheless, to our knowledge, only one study has evaluated the modified Dunn procedure versus in situ pinning for treatment of stable SCFE [34].…”

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

“…In our study three cases (9.3%) developed post operative AVN. In H. HUBER et al [25] study they recorded one case of AVN (3.5%), in Masse et al [28] study they didn't recorded any case of AVN, in T.Slongo et al [24] study they also recorded one case of AVN (4.4%), Sankar et al [29] recorded 7 cases of AVN (26%), Novais et al [26] recorded one case of AVN (7%), Dan Cosma et al [91] didn't record any case of AVN. We didn't record any case with implant failure.…”

“…Masse et al [28] study, postoperative pain score at WOMAC was 0.6 (ranged from 0-4) and postoperative function score at WOMAC was 2,2 (ranged from 0-12). Merle d'Aubigne score ranged from 10 to 18 with mean of 16.8.…”