Surgical Management of Healed Slipped Capital Femoral Epiphysis

Kuzyk, Paul R.T.; Kim, Young-Jo; Millis, Michael B.

doi:10.5435/00124635-201111000-00003

Cited by 44 publications

(37 citation statements)

References 41 publications

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“…23 Consequently, reduction of the SCFE acutely or reorientation of the proximal femur after healing in situ has been advised in an attempt to prevent long-term sequelae including early hip arthritis. 24 Retrospective data support a possible link between residual SCFE deformity and premature hip arthritis. A recent study found subclinical SCFE morphology in over 60% of cases of early hip arthritis.…”

Section: Discussionmentioning

confidence: 94%

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Wylie

Beckmann

Maak

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 94%

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Wylie

Beckmann

Maak

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Femoroacetabular impingement (FAI) in patients with SCFE has been pointed out in several papers [7,13,16,18,21,22,27]. The decision of whether or not FAI should be resolved surgically when diagnosed remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…The decision of whether or not FAI should be resolved surgically when diagnosed remains controversial. Recently, some surgeons have recommended treatment of symptomatic cam-type FAI to prevent subsequent osteoarthrosis [7,16,21]. Although minimally invasive treatments such as arthroscopic osteoplasty may be appropriate to resolve FAI in mild slip cases [18], we believe realignment procedures such as intertrochanteric osteotomies or capital reorientation surgery should be considered in severe slip cases so that the weightbearing part of the femoral head will be covered by hyaline cartilage.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Improvement of Femoroacetabular Impingement After Intertrochanteric Flexion Osteotomy for SCFE

Saisu

Kamegaya

Segawa

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Patients with slipped capital femoral epiphysis (SCFE) may develop cam-type femoroacetabular impingement (FAI). Early management of FAI has been advocated for patients with symptomatic FAI. The various treatment options, including reorientation surgeries, realignment procedures, and osteoplasty, remain controversial. Questions/purposes We asked whether an intertrochanteric flexion osteotomy improved the clinical symptoms of FAI in patients with SCFE and confirmed whether the radiographic signs were compatible with the clinical signs of FAI. Methods We retrospectively reviewed 32 symptomatic patients who underwent 32 intertrochanteric flexion osteotomies for severe SCFE. FAI was diagnosed clinically with a positive impingement sign. The osteotomies were designed preoperatively using CT. Cam-type FAI was evaluated with the modified a angle (b angle) on a Lauenstein view, measured between the proximal femoral shaft axis and the line from the center of the femoral head to the anterior point where the distance of the head center exceeded the femoral head radius. The minimum followup was 2 years (mean, 5 years; range, 2-9 years). Results At last followup, only two patients complained of pain or inconvenience in daily life; the impingement sign was negative in 24 hips (75%). The b angles at last followup were reduced on average by 39°. The postoperative b angle was higher in hips with positive clinical signs of FAI than in those with negative signs. Conclusions Intertrochanteric flexion osteotomy for SCFE improved the clinical and radiographic signs of FAI. The b angle and clinical findings showed compatible improvement. We believe our intertrochanteric flexion osteotomy is a viable option for treating severe SCFE. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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“…This can be achieved by turning the patient slightly towards the contralateral hip and placing a small roll under the ipsilateral buttock. 17 Appropriate capsular management during arthroscopy of the hip is critical. Inadequate capsulotomy can lead to poor exposure and incomplete correction, which is the most common cause of failure in the arthroscopic treatment of FAI.…”

Section: Arthroscopic Osteochondroplasty and Arthroscopicallymentioning

confidence: 99%

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

Azegami

Kosuge

Ramachandran

2013

The Bone & Joint Journal

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Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage. These procedures should be considered for patients with symptoms due to a deformity of the hip secondary to SCFE. Slipped capital femoral epiphysis (SCFE) is the most common adolescent disorder of the hip and the incidence is likely to increase, given the current epidemic of obesity in childhood. 1,2 It has been reported that the age at onset decreases with increasing obesity. 3 SCFE creates a complex deformity of the hip that can result in femoroacetabular impingement (FAI), which may lead to the early development of osteoarthritis (OA) of the hip. 4 Retrospective studies of patients with untreated SCFE and of pinning in situ without realignment suggest that the severity of the slip correlates with the subsequent radiological evidence of OA and poor clinical outcome scores, but is not necessarily predictive of FAI. 5,6 In a retrospective study by Dodds et al, 6 32% of patients (16 of 49) who previously presented to their institution with SCFE were found to have clinical signs of FAI.In situ pinning is commonly undertaken and is a relatively low risk procedure relying on remodelling of the proximal femur. However, it may still result in radiological osteoarthritic changes and a poor clinical outcome. Surgical management of FAI is aimed at restoring a more normal femoral head-neck offset in order to increase clearance and prevent femoral abutment against the acetabular edge. Various management strategies have been described, including arthroscopic osteochondroplasty, arthroscopically assisted osteochondroplasty via arthrotomy, surgical dislocation osteochondroplasty, proximal femoral osteotomy and peri-acetabular osteotomy. PathophysiologyBased on the type of abnormal morphology, FAI can be divided into three types: cam, pincer, and mixed-type. 4 In cam-type impingement the prominent area, typically on the anterolateral femoral neck, abuts the acetabular rim during forceful movement, especially in flexion and internal rotation, leading to damage of the labral-chondral complex. 7 In pincertype impingement the abnormality is on the acetabular side, involving focal or global overcoverage of the femoral head leading to damage of the femoral head-neck region and labrum. 8,9 FAI can also be classified as primary and secondary (Fig. 1).In SCFE, the relative positioning of the femoral head leads to prominence of the anterolateral femoral metaphysis (Fig. 2). 10 Th...

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Surgical Management of Healed Slipped Capital Femoral Epiphysis

Cited by 44 publications

References 41 publications

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Arthroscopic Treatment of Mild to Moderate Deformity After Slipped Capital Femoral Epiphysis: Intra-operative Findings and Functional Outcomes

Postoperative Improvement of Femoroacetabular Impingement After Intertrochanteric Flexion Osteotomy for SCFE

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis

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