The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome

Abstract

Purpose Slipped capital femoral epiphysis (SCFE) represents the preliminary stage of osteoarthritis. Reliable tools for outcome evaluation should be developed to prevent persisting defects. The functional outcome of SCFEpatients after growth arrest is analysed by instrumented 3D-gait analysis (GA). The results are matched to the clinical examination findings. Methods A total of 39 SCFE patients after growth arrest (18.8 years; BMI 26.5 kg/m²) with unilateral affection were included. The clinical results were classified according to Harris hip and clinical Heyman Herndon scores. 3D-GAparameters were evaluated and compared to the sound side and a group of 40 healthy adults (28.0 years; 21.9 kg/m²). The subgroup analysis was performed according to clinical results. Results The clinical examination revealed very good results. GA could detect even small alterations. Some parameters indicated sustained functional impairments: Compared to the control group patients' walking speed (p=0.022), step frequency (p<0.001) and single support of the slip side (p<0.001) decreased, while step width (p= 0.014), double support (p=0.004) and stance time of sound side increased (p=0.001). For kinematics patients, the sagittal range of motion (ROM) of pelvis (p<0.001) and the external rotation of the ankle on both sides increased (p=0.011) and sagittal ROM of hip (p=0.002) and knee flexion of slip side (p<0.001) decreased. The sagittal ROM of the ankle on the slip side decreased compared to the sound side (p=0.003). Subgroup analysis revealed a positive correlation between clinically unsatisfying results and GA parameters. Conclusions Functional impairments in SCFE-patients can be found even after growth arrest. Alterations are explained partly by the disease and partly by patients' constitution. BMI-matched controls and long-term follow-up are needed.

Radiological outcome and gait function of SCFE patients after growth arrest

“…For kinematic parameters in the sagittal plane, the worse radiological subgroup showed a slight-but statistically significant-increase in the ROM of the pelvis. This fits findings of the analysis of the whole study population [8].…”

“…Usually, only subjective, clinical, and radiological parameters have been evaluated [4][5][6]. Gait impairments in SCFE patients after growth arrest have been demonstrated by Westhoff et al [8]. Not only the movement pattern of the hip joint but also of the pelvis, knee, and ankle were affected.…”

Remodelling of femoral head–neck junction in slipped capital femoral epiphysis: a multicentre study

“…In relation to the longer follow-up, however, Bellemans et al showed 10 % of hips had poor function due to residual deformity at the anterior femoral head-neck junction in a study averaging 11.4 years of follow-up [17]. Westhoff et al reported ROM of the hip was smaller on the slip side and that patients showed totally less positive mechanical ability even after growth arrest [18]. The concept of FAI helps to explain the development of premature OA in patients with SCFE, as hips with decreased head-neck offset (cam deformity) are susceptible to continuous impingement.…”

Relationships Between Severity of Deformity and Impingement in Slipped Capital Femoral Epiphysis

“…This is consistent with SCFE patients walking with their leg in forced external rotation. 20 Strengths of this work include using 1 normal bone model to create clinically relevant SCFE deformities, which allows direct comparisons of degree of deformity without intersubject variability. Previous work in modeling impingement and ROM in SCFE has relied on simplified geometrical shapes, 11 which may not adequately represent bony hip geometry.…”