The asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis

Abstract

Prophylactic contralateral fixation in unilateral slipped capital femoral epiphysis (SCFE) remains a controversial issue. In this study, 66 patients treated for unilateral SCFE (July 1997-April 2009) were screened for complications with need for surgical reintervention in the asymptomatic contralateral hip. Except for one patient, prophylactic fixation was performed in all cases. Major complications such as avascular necrosis were not seen; minor complications such as wound revision occurred in 4.6% (three of 65). In 16.9% (11/65) secondary loss of fixation with need for second fixation occurred. As the need for second fixation arose mostly bilaterally (10.7%, 7/65), only four patients (6.2%) required an additional surgical procedure for second fixation. Children who needed second fixation were significantly younger (11.8 years) than those who did not (13.1 years, P=0.013). In conclusion, this retrospective analysis shows that prophylactic contralateral fixation in SCFE is a safe procedure with no major complications and an acceptable rate of minor complications. When Kirschner wires are used for prophylactic pinning, there is a possibility of secondary loss of fixation due to length growth at the level of the physis. To avoid the need for secondary fixation, screw epiphysiodesis might be considered.

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

“…Prophylactic pinning is offered at some centers to children with unilateral disease to prevent a contralateral slip. Prophylactic pinning is thought to have low morbidity [6,16,41]. However, Woelfle et al [41] reported a 10% revision rate (seven of 65 patients) for hips prophylactically pinned with K-wires.…”

“…Prophylactic pinning is thought to have low morbidity [6,16,41]. However, Woelfle et al [41] reported a 10% revision rate (seven of 65 patients) for hips prophylactically pinned with K-wires. Further, avascular necrosis and subtrochanteric fracture after prophylactic screw fixation of the contralateral hip have been reported [20].…”

Imaging Characteristics of Contralateral Asymptomatic Patellofemoral Joints in Patients with Unilateral Instability

“…abnormalities, including subtalar coalition (15), slipped capital femoral epiphysis (16), and trochlear dysplasia, (17) and, therefore, elucidation of a primary morphologic abnormality of the currently asymptomatic contralateral patellofemoral joints may provide insight into the underlying predisposing factors for PI. Additionally, these underlying anatomic and functional abnormalities may predispose the contralateral asymptomatic joints to future anterior knee pain, instability, and OA.…”

Slipped Capital Femoral Epiphysis

“…25 Currently, there is a growing body of evidence that supports routine prophylactic in situ fixation in unilateral SCFE because the associated complication rate is acceptable compared with the high incidence of complications from a contralateral SCFE. [66][67][68] …”