Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

Abstract

Background The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques. Questions/purposes We therefore addressed the following questions: (1) What is the rate of osteonecrosis of the femoral head after treatment of unstable SCFE? (2) What treatment modalities have been used for unstable SCFE and (3) what are the reported complications? Methods We performed a systematic electronic literature search for the keywords unstable and slipped capital femoral epiphysis and identified 199 articles. Of these, 60 met our inclusion criteria. Fifteen articles were included for analysis. Results The literature concerning the treatment and results of unstable SCFE is retrospective Level IV data that suggest an overall rate of osteonecrosis of 23.9%. Multiple treatment modalities were used for unstable SCFE treatment with varying, inconsistently recorded complications over the reporting period. Conclusions We found limited data concerning the rate of osteonecrosis and complications after treatment of unstable SCFE. Considering recent widespread interest in the modified Dunn procedure and the possibility of iatrogenic osteonecrosis, there is a need for prospective studies to identify complications and establish outcome based on standardized scores for established and emerging treatments of unstable SCFE.

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

“…Second, our cohort represents the learning curve of the three surgeons. Thus, the overall proportion of patients who developed osteonecrosis may be higher than the expected proportion reported by the originators of the technique [13,14,29]. However, all surgeons were experienced in the surgical dislocation approach and the proportion of osteonecrosis in this series compares well to other recent studies [24,25].…”

“…The increased attention is most likely related to the fact that osteonecrosis of the femoral head was not reported in the first descriptive studies [13,14,29]. Recent studies, however, have reported that approximately 25% of patients undergoing a modified Dunn for unstable SCFE developed osteonecrosis [21,22].…”

“…Instability of the SCFE has been cited as an important prognostic factor as a result of its association with the development of osteonecrosis of the femoral head [16,17,[27][28][29]. Osteonecrosis is the most severe complication after unstable SCFE treatment.…”

“…Osteonecrosis is the most severe complication after unstable SCFE treatment. Although previous studies [10,16,17,19,20,23,[27][28][29] vary widely in terms of the proportion of patients who develop osteonecrosis after unstable SCFE, a recent systematic review of the literature reported an overall rate of 24% [29]. Osteonecrosis leads to femoral head collapse and further hip osteoarthritis, and it is the most common indication for hip arthroplasty in patients with SCFE [11,12].…”

Is the femoral head dead or alive before surgery of slipped capital femoral epiphysis? Interest of perfusion Magnetic Resonance Imaging

“…The rate of AVN in SCFE varies in literature from 5% to 47%. 1 Zaltz et al 23 made a literature review and found a cumulative rate of osteonecrosis of 23.9% among patients with SCFE classified as unstable. In our study, we had three osteonecrosis on nine unstable hips compared to ten stable hips without any case of AVN.…”