The management of avascular necrosis after slipped capital femoral epiphysis

Abstract

Avascular necrosis is a serious complication of slipped capital femoral epiphysis and is difficult to treat. The reported incidence varies from 3% to 47% of patients. The aims of treatment are to maintain the range of movement of the hip and to prevent collapse of the femoral head. At present there are no clear guidelines for the management of this condition and treatment can be difficult and unrewarding. We have used examination under anaesthesia and dynamic arthrography to investigate avascular necrosis and to determine the appropriate method of treatment. We present 20 consecutive cases of avascular necrosis in patients presenting with slipped capital femoral epiphysis and describe the results of treatment with a mean follow-up of over eight years (71 to 121 months). In patients who were suitable for joint preservation (14), we report a ten-year survivorship of the hip joint of 75% and a mean Harris hip score of 82 (44 to 98).

Nonoperative treatment of slipped capital femoral epiphysis: a scientific study

“…Jerre, in a series of 200 slipped femoral epiphyses treated mainly by closed reduction and plaster immobilization, found nine hips (4.5%) with articular cartilage necrosis [13]; in this study, chondrolysis affected 12 hips (11.3%): four presented a temporary form of chondrolysis (7.5%), with eight being permanent. Writings on this subject have shown a predominance of females over males [14,15]; in this series, chondrolysis was also predominant in females over males.…”

“…These disadvantages should be taken into consideration because of the risks of pinning by means of wires or screws, and the serious sequelae which include pin penetration, fracture, infection, pin breakage, growth disturbance, wound problems, subsequent slippage, difficulty in pin extraction during hardware removal, nail slipping into the joint, nail extruding, nails bending, avascular necrosis, as well as chondrolysis [7,14,15,24,25]. The global incidence of chondrolysis is 7% with all forms of treatment [26].…”

Avascular necrosis post unstable slipped capital femoral epiphysis: a treatment algorithm with staged hinged hip distraction: mid-term results

“…1 It leads to rapid deterioration in joint function and significant morbidity, often necessitating the need for joint replacement or hip fusion. 2 In an unstable SCFE the risk of AVN is remarkably high. 3 The long-term function of such severe unstable slips with AVN is not encouraging.…”

“…Currently available treatment strategies aim to prevent collapse and maintain the joint range of motion by various strategies. 4 Femoral osteotomies, 5 trap door bone grafting, 6 hinged distraction, 7 subchondral drilling, 4 shelf acetabular procedures 2 have all been described. These procedures, however, do not address deformity in the femoral neck post SCFE.…”

A comparison study of radiographic and computerized tomographic angles in slipped capital femoral epiphysis

“…Early diagnosis and appropriate treatment may reduce the incidence of complications and functional loss. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Imaging tests are indispensable to confirm the diagnosis and classify the disease. Anteroposterior hip X-ray and Lauenstein-type profile X-ray are usually sufficient for diagnostic confirmation and classification.…”