|
1
|
Nowicki P, Carveth S, Miller K, Flakne J, Kramer S, Reynolds JL, Rowland J, Kelly D, Cassidy J, Sawyer J. In Situ Screw Fixation for Stable Slipped Capital Femoral Epiphysis Is Safely Treated in Both Inpatient and Outpatient Settings. J Am Acad Orthop Surg 2025:00124635-990000000-01320. [PMID: 40339137 DOI: 10.5435/jaaos-d-24-01271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 03/18/2025] [Indexed: 05/10/2025] Open
Abstract
BACKGROUND Patients diagnosed with slipped capital femoral epiphysis (SCFE) are admitted and treated with timely screw stabilization to prevent instability. This study compares the safety of SCFE stabilization in an inpatient versus outpatient setting, specifically evaluating the rates of revision procedures and complications between each setting. METHODS A retrospective review of all stable SCFEs treated at two, level 1, pediatric trauma centers with a minimum follow-up of 12 months was done. Comparisons were made between inpatient and outpatient groups. General demographics were collected along with slip severity as determined by Southwick angle. Outcomes reviewed included symptomatic femoroacetabular impingement and postoperative complications, including slip angle progression and revision screw fixation. Independent t-test was used to evaluate quantitative variables, chi-squared test for qualitative variables, and logistic regression for differences between severity groups. P values of <0.05 were considered notable. RESULTS One hundred seventy-one SCFEs in 140 patients were reviewed. Overall, 108 were stabilized as an inpatient and 63 as an outpatient. No notable differences between either group were found when assessing for overall complications (P = 0.1705) and need for revision surgery (P = 0.1657). Frog-leg lateral hip angles progressed markedly over time for all patients (P = 0.0413) but not between patient groups (P = 0.0981). The odds of complication were 2 times higher (P = 0.023), and symptomatic femoroacetabular impingement were 2.1 times higher (P = 0.0027) for each increase in slip severity relative to the previous severity level. Interrater reliabilities for Southwick angles were good or excellent across all time measurements (intraclass correlation ≥0.8). DISCUSSION Our data confirm that no difference exists between complication and revision rates with SCFE stabilization in an inpatient or outpatient setting. Although we did not perform a comprehensive safety analysis, outpatient SCFE stabilizations were associated with a low complication rate when performed in a high-volume center. More work is needed to establish proper outpatient SCFE treatment guidelines. LEVEL OF EVIDENCE Level III case-control series.
Collapse
Affiliation(s)
- Philip Nowicki
- From the Corewell Health Helen DeVos Children's Hospital, Michigan State University College of Human Medicine Department of Surgery, Grand Rapids, MI (Nowicki, Cassidy, and Sawyer), Iowa Ortho, Des Moines, IA (Carveth), Gillette Children's Hospital, St Paul, MN (Miller), Corewell Health Department of Orthopaedic Surgery, Grand Rapids, MI (Flakne), ECU Health, Greenville, NC (Kramer), University of Kentucky Department of Orthopedic Surgery and Sports Medicine, Lexington, KY (Reynolds), LeBonheur Children's Hospital, Memphis, TN (Rowland), and Campbell Clinic Orthopaedics, LeBonheur Children's Hospital, Memphis, TN (Kelly)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
2
|
Rosenbaum DG, Cooper AP. Slipped capital femoral epiphysis: emphasis on early recognition and potential pitfalls. Skeletal Radiol 2025; 54:807-818. [PMID: 39251420 DOI: 10.1007/s00256-024-04798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/11/2024]
Abstract
Slipped capital femoral epiphysis is a shearing injury through the growth plate of the proximal femur and is the most common hip disorder in adolescence. Delays in diagnosis persist across practice settings despite ongoing innovations in imaging. Recent insights into pathomechanics highlight the importance of femoral head surface morphology and rotational microinstability centered at the epiphyseal tubercle in causing early physeal changes, which can be detected on imaging prior to frank slip. Scrutiny of physeal morphology and comparison to the contralateral hip is critical at all stages of disease progression, and improper technique may result in undue diagnostic delay. Selective use of cross-sectional imaging can be helpful for troubleshooting equivocal early slips and can inform operative technique and adjuvant therapy candidacy in more severe cases. This review provides a comprehensive approach to imaging suspected slipped capital femoral epiphysis, with an emphasis on early detection and potential pitfalls.
Collapse
Affiliation(s)
- Daniel G Rosenbaum
- Department of Radiology, BC Children's Hospital, University of British Columbia, 4480 Oak St., Vancouver, BC, V6H 3V4, Canada.
| | - Anthony P Cooper
- Department of Orthopaedic Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
|
3
|
Xu Y, Fu G, Feng C, Huang L, Ma Y, Zhang Y, Zhou Y, Luo X, Lu M, Yang J, Wang Y, Lv X, Jiang X, Yang Z. Robot-assisted percutaneous cannulated screw fixation in the treatment of slipped capital femoral epiphysis. J Child Orthop 2025; 19:158-165. [PMID: 39959673 PMCID: PMC11829277 DOI: 10.1177/18632521251319987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 01/25/2025] [Indexed: 02/18/2025] Open
Abstract
Purpose To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips. Methods Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12-36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot. Results All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up (P < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 (P < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head. Conclusion Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory. Level of Evidence Level 4, Case Series.
Collapse
Affiliation(s)
- Yunfeng Xu
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Chao Feng
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Lin Huang
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yuan Ma
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yucheng Zhang
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yuan Zhou
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xiao Luo
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Lu
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Yang
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yukun Wang
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xuemin Lv
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Xieyuan Jiang
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., LTD, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| |
Collapse
|
|
4
|
Lee KR, Kim WJ, Lee W, Shin CH, Cho TJ, Choi IH, Song MH. Treatment Outcomes at Skeletal Maturity After Physeal-sparing Procedures for Early-onset Slipped Capital Femoral Epiphysis Using a Long Screw With a Short-threaded Tip. J Pediatr Orthop 2025:01241398-990000000-00779. [PMID: 40025786 DOI: 10.1097/bpo.0000000000002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2025]
Abstract
BACKGROUND Physeal-sparing procedures are preferred for treating early-onset slipped capital femoral epiphysis (SCFE), reducing limb-length discrepancy (LLD), and femoroacetabular impingement (FAI). This study aimed to investigate the treatment outcomes after physeal-sparing procedures for early-onset SCFE. METHODS We reviewed medical and radiographic records of SCFE patients from 1992 to 2022. Patients under 11 years old and followed up to skeletal maturity were included. Physeal-sparing procedures using a long screw with a short-threaded tip were performed in patients with mild to moderate slips since 2008. Patients were dichotomized into physeal-sparing and traditional in situ fixation (ISF) groups. Radiographic and clinical outcomes were comparatively analyzed between the groups. RESULTS Fifteen patients underwent physeal-sparing procedures, whereas 12 patients underwent traditional ISF. There was no further slippage in either group. During follow-up, slip angle was significantly decreased in the physeal-sparing group compared with the traditional ISF group (22.0 vs. 8.8 deg, respectively, P<0.01). LLD of>20 mm did not occur in the physeal-sparing group, but was observed in the traditional ISF group (P<0.01). Femoral neck length (FNL), articulo-trochanteric distance (ATD), α angle, and femoral head-neck offset of the physeal-sparing side were comparable to the unaffected healthy side (P=0.08, P=0.25, P=0.14, P=0.13), but differences were seen in healthy versus traditional ISF sides (P<0.01, P<0.01, P<0.01, and P<0.01, respectively). In addition, consistent growth was observed in the physeal-sparing side, but premature physeal arrest developed in the traditional ISF side. Six physeal-sparing patients required screw change procedures as the proximal femur outgrew the screw. The physeal-sparing group scored higher modified Harris Hip Score points than the traditional ISF group (89.5 vs. 85.3, respectively). CONCLUSIONS Using a long screw with a short-threaded tip can stabilize the proximal femoral physis. It may also allow the continual growth and remodeling of the proximal femur in the treatment of early-onset SCFE. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Kwang Ryeol Lee
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
| | - Whei Jun Kim
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
- GKT School of Medical Education, King's College London, London, UK
| | - Wonik Lee
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
| | - In Ho Choi
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Mi Hyun Song
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine
| |
Collapse
|
|
5
|
Siller RL, Haney KF, Lee AK, Carmichael KD. Rates of Revision for Progressive Deformity and Contralateral Slipped Capital Femoral Epiphysis Using a Partially Threaded Cannulated Screw: A Retrospective Review. Orthopedics 2025; 48:e100-e104. [PMID: 40052877 DOI: 10.3928/01477447-20250217-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is a problem affecting the pediatric population, with high rates of re-slip and contralateral pinnings. The purpose of this study was to identify both rates of recurrence and contralateral slips after in situ pinning of stable and unstable SCFE. MATERIALS AND METHODS Pediatric patients who underwent in situ and revision pinning of SCFE from January 2000 to December 2022 were reviewed for subsequent procedures, including contralateral pinning and revision procedures. All hips were pinned in situ using a technique consisting of a single, cannulated, 6.5-mm partially threaded screw. Association with age and sex were prioritized and compared with previous literature. Data analysis was performed using t tests and chi-square tests. Statistical significance was set at P>.05. RESULTS Eighty-eight patients were selected for review, with a total of 124 native hips pinned and 7 revision hips (5.6% revised for progression of deformity). Twelve contralateral hips underwent sequential pinning for contralateral slip (24.0% of all unilateral procedures performed). Seventy-four percent of patients were male. The mean age at initial slip for patients who did not undergo a subsequent procedure was 13.0±1.5 years, compared with 10.8±1.6 years for contralateral slips and 11.5±1.5 years for revision hips (P<.001). CONCLUSION The rates of revision and contralateral slip were comparable to and slightly lower than those reported in the current literature. The complication rate for this procedure is low. This study demonstrates a safe and an efficient technique for management of SCFE. [Orthopedics. 2025;48(2):e100-e104.].
Collapse
|
|
6
|
DeRogatis MJ, McGlone PJ, DeFrancesco C, Anari JB. Slipped Capital Femoral Epiphysis in a 26-Month-Old Boy with Cerebral Palsy: A Case Report. JBJS Case Connect 2025; 15:01709767-202503000-00064. [PMID: 40085726 DOI: 10.2106/jbjs.cc.24.00599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2025]
Abstract
CASE A 26-month-old child with spastic quadriplegic cerebral palsy, TPN dependence, laryngomalacia, and G6PD deficiency presented with right hip pain with no known recent trauma. Imaging revealed a slipped capital femoral epiphysis (SCFE). The patient underwent hip irrigation and debridement for potential septic arthritis, with SCFE stabilized using buried 2.0 K-wires. A single-leg spica cast was applied. Follow-up showed symptom improvement and no SCFE progression. CONCLUSION This is the first reported case of SCFE in a child aged younger than 3 years without seizure history. SCFE should be considered in high-risk young patients with metabolic conditions or prior radiation therapy, guided by detailed evaluation and imaging.
Collapse
Affiliation(s)
- Michael J DeRogatis
- Department of Orthopaedic Surgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - Patrick J McGlone
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christopher DeFrancesco
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason B Anari
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
|
7
|
van Stralen RA, Roelen MCR, Moerman S, Witbreuk MMEH, Witlox MA, ten Ham A, Eygendaal D, Reijman M, Tolk JJ. GUIDANCE study: guided growth of the proximal femur to prevent further hip migration in patients with cerebral palsy-study protocol for a multicentre randomised controlled trial. BMJ Open 2024; 14:e091073. [PMID: 39663160 PMCID: PMC11647319 DOI: 10.1136/bmjopen-2024-091073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 11/11/2024] [Indexed: 12/13/2024] Open
Abstract
INTRODUCTION Up to one-third of patients with cerebral palsy (CP) develop hip migration. Current standard care for early hip migration is bilateral adductor-psoas tenotomy; however, the failure rate is relatively high with 34%-74% of patients with CP requiring secondary hip surgery. Using temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF), the morphology of the hip can be changed. This technique aims to reduce further hip migration and the need for secondary surgical management. Further research is necessary to determine the benefit of TMH-PF in addition to adductor-psoas tenotomy. The hypothesis of this study is that TMH-PF combined with adductor-psoas release decreases the chance of progressive hip migration and the need for secondary hip surgery, compared with adductor-psoas release alone. METHODS AND ANALYSIS The GUIDANCE study is an open-label multicentre randomised controlled trial. Patients with CP aged between 2 and 8 years, with spastic CP-Gross Motor Function Classification System IV or V, hip abduction ≤40° and hip migration of 30%-50% can be included in this trial. They will be randomised into a control arm (adductor-psoas tenotomy) or an intervention arm (adductor-psoas tenotomy+TMH PH). The primary outcome will be treatment failure at 5-year follow-up. At 2-year follow-up a preliminary analysis will be performed. Secondary outcomes will be differences in patient-reported outcome measures (CPCHILD and CPG pain score), range of motion, radiological measurements including head shaft angle and hip migration percentage and three-dimensional (3D) morphological changes to the proximal femur. Furthermore, an analysis will be performed to identify predictors for treatment failure in both treatment arms. ETHICS AND DISSEMINATION The GUIDANCE study should provide evidence on the effectiveness of TMH-PF in addition to adductor-psoas tenotomy in children with CP with early hip migration. If beneficial, larger hip reconstructive procedures can be delayed or prevented, providing a distinct benefit for these vulnerable children. The study's strengths lie in its methodological framework, incorporating randomised allocation and intervention assessment. The main limitation is the inability to blind the treating physician or the researcher for the treatment arm the participant is allocated to. The results of the GUIDANCE study will be presented at scientific meetings and published in international peer-reviewed journals. The aim is to publish the results at 2 years follow-up and 5 years follow-up and to publish the results of the analysis on the 3D morphology of the hip after TMH-PF. Individual de-identified participant data that underlie the results from the GUIDANCE study and the study protocol will be shared if requested. TRIAL REGISTRATION NUMBER Clinical Trial Registry number: NCT06118736. Registered on 3 November 2023.
Collapse
Affiliation(s)
- Renée Anne van Stralen
- Orthopedics and Sports Medicine, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, The Netherlands
| | | | - Sophie Moerman
- Orthopedic Surgery, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | | | - M Adhiambo Witlox
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arno ten Ham
- Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
| | - Denise Eygendaal
- Orthopedics and Sports Medicine, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Max Reijman
- Orthopedics and Sports Medicine, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Jaap Johannes Tolk
- Orthopedics and Sports Medicine, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| |
Collapse
|
|
8
|
Dwan LN, Little DG, Birke O, Wojciechowski EA, Mudge AJ, McKay MJ, St George J, Burns J. Two-year 3D gait outcomes following in-situ pinning or modified Dunn procedure in children with slipped capital femoral epiphysis. Gait Posture 2024; 114:243-249. [PMID: 39423665 DOI: 10.1016/j.gaitpost.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/12/2024] [Accepted: 10/13/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Slipped Capital Femoral Epiphysis (SCFE) is femoral head slippage off the femoral neck through the physis occurring in children aged 8-16 years. Surgical intervention is required in all paediatric cases and there is no universal agreement on choice of surgical procedure. RESEARCH QUESTION What are the two-year 3D gait outcomes in children with SCFE who have undergone in-situ pinning (PIN) or modified Dunn procedure (MDP) compared with normative reference values? METHODS 17 children with SCFE who had undergone PIN (n=7, slip severity mild to moderate) or MDP (n=10, slip severity moderate to severe) surgical procedures prospectively underwent a 3D gait analysis post-surgery (2∙0 ± 0∙5 years). Ten age-matched children were also recruited to provide normative reference values. The conventional gait model was modified to incorporate Hara hip equations and Lerner pelvic tracking methods. Gait Profile Scores, Gait Variable Scores, kinematics, kinetics and spatiotemporal data were calculated for each group. RESULTS Overall gait pattern, determined by the Gait Profile Score, indicated that both SCFE groups differed from the normative reference group (PIN 6∙6 ± 2∙5⁰, MDP 6∙2 ± 2∙0⁰ vs. 4∙0 ± 1∙3⁰ norm, p<0∙05). Normalised walking speed was reduced in the MDP group (0∙40 ± 0∙04) compared to the normative reference group (0∙46 ± 0∙06; p=0∙032). SIGNIFICANCE Gait patterns of children with SCFE treated with PIN was more markedly altered than that of children with SCFE treated with MDP, despite having lower SCFE severity. Increased external hip rotation observed in the PIN group may be a pre-cursor for osteoarthritis in adulthood. Therefore the use of the corrective MDP which normalises hip rotation may be beneficial for reducing functional impairments.
Collapse
Affiliation(s)
- L N Dwan
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
| | - D G Little
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - O Birke
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - E A Wojciechowski
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - A J Mudge
- Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - M J McKay
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - J St George
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - J Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network, Westmead, NSW, Australia; St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
|
9
|
Negru M, Dinu AR, Amaricai E, Catan L, Bolovan AD, Lazarescu AE, Stanciulescu CM, Boia ES, Popoiu CM. Stabilometry in Relation to Hip and Knee Muscle Force in Children with Surgically Treated Unilateral Slipped Capital Femoral Epiphysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1186. [PMID: 39457151 PMCID: PMC11506437 DOI: 10.3390/children11101186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 09/22/2024] [Accepted: 09/26/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND/OBJECTIVES The main aim of our study was to analyze the stabilometric parameters in relation to hip and knee muscle force in children with unilateral slipped capital femoral epiphysis (SCFE) who had undergone surgical treatment. Another objective was to compare the stabilometry in three testing situations (eyes open, eyes closed, and head retroflexed). METHODS In total, 26 patients with unilateral right SCFE treated via in situ fixation with one percutaneous screw performed stabilometry assessments under three different situations (with their eyes open, with their eyes closed, and with their head retroflexed) and isometric muscle force assessment of the bilateral hip flexors, extensors, abductors and adductors and bilateral knee flexors and extensors. RESULTS No significant differences between the right side (affected hip) and left side (non-affected hip) were recorded for all of the tested muscle groups. We found significant negative correlations between the 90% confidence ellipse area (eyes open condition) and left knee extensors (p = 0.028), right knee flexors (p = 0.041), and left knee flexors (p = 0.02), respectively. When performing the comparison between the eyes open and eyes closed situations, there were significant differences in CoP path length (p < 0.0001) and maximum CoP speed (p = 0.048); the parameters increased in the eyes closed situation. CONCLUSIONS Better postural stability is acquired when assessed with eyes open or with the head retroflexed in contrast with eyes closed testing.
Collapse
Affiliation(s)
- Marius Negru
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.N.); (A.D.B.)
| | - Anca Raluca Dinu
- Department of Rehabilitation, Physical Medicine and Rheumatology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (E.A.); (L.C.)
- Research Center for Assessment of Human Motion, Functionality and Disability, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Elena Amaricai
- Department of Rehabilitation, Physical Medicine and Rheumatology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (E.A.); (L.C.)
- Research Center for Assessment of Human Motion, Functionality and Disability, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Liliana Catan
- Department of Rehabilitation, Physical Medicine and Rheumatology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (E.A.); (L.C.)
- Research Center for Assessment of Human Motion, Functionality and Disability, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Daniel Bolovan
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.N.); (A.D.B.)
- Department of Rehabilitation, Physical Medicine and Rheumatology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (E.A.); (L.C.)
- Research Center for Assessment of Human Motion, Functionality and Disability, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Emil Lazarescu
- Department of Anatomy, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- 2nd Clinic of Orthopaedics and Traumatology, Timisoara Emergency County Hospital, 300723 Timisoara, Romania
- Teodor Sora Research Centre, Department of Orthopaedics and Traumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Corina Maria Stanciulescu
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.S.); (E.S.B.); (C.M.P.)
| | - Eugen Sorin Boia
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.S.); (E.S.B.); (C.M.P.)
| | - Calin Marius Popoiu
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.M.S.); (E.S.B.); (C.M.P.)
| |
Collapse
|
|
10
|
Chervonski E, Wingo T, Pargas-Colina C, Castañeda P. Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis. J Pediatr Orthop B 2024; 33:437-442. [PMID: 37811577 PMCID: PMC11288391 DOI: 10.1097/bpb.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
Stable slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder managed with in situ fixation of the proximal femoral epiphysis, otherwise known as 'pinning the hip'. The objective of this study was to characterize how the choice of implant for in situ fixation of stable SCFE has changed over time. A systematic review of publications concerning in situ fixation of stable SCFE from January 1993 to November 2021 was conducted. The change in the type, diameter, and number of implants used in publications over time and the age of their respective patient cohorts was evaluated. A total of 207 articles met inclusion criteria. There was an increase in publications using cannulated screws over time ( P = 0.0113). As the yearly percentage of publications using threadless non-cannulated implants decreased ( P = 0.0309), the percentage using cannulated screws increased ( P = 0.0047). Single-implant fixation also increased ( P = 0.0409). While there was no difference in the rate of increase of implants < 7 mm or ≥ 7 mm in diameter ( P = 0.299), patients with larger-diameter implants were, on average, older than patients with smaller-diameter implants ( P = 0.0462). In general, the age of patients undergoing in situ fixation of stable SCFE has not changed ( P = 0.595). Irrespective of patient-specific considerations, single cannulated screws have become the implant of choice for in situ fixation of stable SCFE. There has not been a consensus on the optimal implant diameter; instead, patient-specific considerations are of paramount importance in this decision.
Collapse
Affiliation(s)
| | - Taylor Wingo
- Department of Orthopaedic Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, New York, USA
| | - Carlos Pargas-Colina
- Department of Orthopaedic Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, New York, USA
| | - Pablo Castañeda
- Department of Orthopaedic Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, New York, USA
| |
Collapse
|
|
11
|
Klatt JB, Metz AK, Froerer DL, Featherall J, Cheminant JR, Rosenthal RM, Aoki SK. Association of Relative Skeletal Immaturity of the Triradiate Cartilage with Increased Proximal Femoral Deformity in Prophylactic Fixation for Slipped Capital Femoral Epiphysis: A Radiographic Study. J Am Acad Orthop Surg 2024; 32:401-409. [PMID: 38261798 DOI: 10.5435/jaaos-d-22-01204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The purpose of this study was to describe proximal femoral deformity after contralateral hip prophylactic fixation of slipped capital femoral epiphysis (SCFE) in patients and the association of relative skeletal immaturity with this deformity. METHODS A retrospective review of patients presenting with a SCFE was conducted from 2009 to 2015. Inclusion criteria were (1) radiographic evidence of a unilateral SCFE treated with in situ fixation, (2) contralateral prophylactic fixation of an unslipped hip, and (3) at least 3 years of follow-up. Measurements were made on radiographs and included greater trochanter height relative to the center of the femoral head, femoral head-neck offset, and femoral neck length. Skeletal maturity was evaluated by assessing the status of the proximal femoral physis and triradiate cartilage (TRC) of the hip, in addition to the length of time to closure of these physes. Values were compared from initial presentation to final follow-up. Statistical analysis included descriptive statistics and linear regression. RESULTS Twenty-seven patients were included. Bivariable linear regression demonstrated that an increased relative trochanteric overgrowth was associated with TRC width (β = 3.048, R = 0.585, P = 0.001) and an open TRC (β = -11.400, R = 0.227, P = 0.012). Time to proximal femoral physis closure (β = 1.963, R = 0.444, P = 0.020) and TRC closure (β = 1.983, R = 0.486, P = 0.010) were predictive of increased deformity. In addition, multivariable elimination linear regression demonstrated that TRC width (β = 3.048, R = 0.585, P = 0.001) was predictive of an increased relative trochanteric overgrowth. DISCUSSION Patients with an open TRC and increased TRC width are associated with increased relative trochanteric overgrowth when undergoing prophylactic fixation for a unilateral SCFE. Increased caution should be exercised when considering contralateral hip prophylactic fixation in skeletally immature patients presenting with a unilateral SCFE. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Joshua B Klatt
- From the Department of Orthopaedic Surgery, University of Utah (Klatt, Metz, Froerer, Featherall, Cheminant, Rosenthal, and Aoki), and the School of Medicine, University of Utah, Salt Lake City, UT (Froerer)
| | | | | | | | | | | | | |
Collapse
|
|
12
|
Singh A, Kotzur T, Torres-Izquierdo B, Momtaz D, Gonuguntla R, Hoveidaei AH, Seifi A, Galán-Olleros M, Hosseinzadeh P. Decade-long Trends in Incidence of Slipped Capital Femoral Epiphysis in the United States: A Nationwide Database Analysis of Over 33 Million Patients. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00016. [PMID: 38775549 PMCID: PMC11111394 DOI: 10.5435/jaaosglobal-d-24-00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Slipped capital femoral epiphysis (SCFE) is a prevalent pediatric hip disorder linked to severe complications, with childhood obesity as a crucial risk factor. Despite the rising obesity rates, contemporary data on SCFE's epidemiology remain scarce in the United States. This study examined SCFE incidence trends and demographic risk factors in the United States over a decade. METHODS A decade-long (2011 to 2020) retrospective cohort study was undertaken using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients aged younger than 18 years were identified and further analyzed if diagnosed with SCFE through ICD-9 or ICD-10 codes. Key metrics included demographics variables, with multivariate regression assessing demographic factors tied to SCFE, and yearly incidence calculated. RESULTS Of 33,180,028 pediatric patients, 11,738 (0.04%) were diagnosed with SCFE. The incidence escalated from 2.46 to 5.96 per 10,000 children, from 2011 to 2020, mirroring childhood obesity trends. Lower socioeconomic status children were predominantly affected. Multivariate analysis revealed reduced SCFE risk in female patients, while Black and Hispanic ethnicities, alongside the Western geographic location, had an increased risk. CONCLUSION This study underscores a twofold increase in SCFE incidence over the past decade, aligning with childhood obesity upsurge. Moreover, SCFE disproportionately affects lower SES children, with male sex, Black and Hispanic ethnicities amplifying the risk. This calls for targeted interventions to mitigate SCFE's effect, especially amidst the vulnerable populations.
Collapse
Affiliation(s)
- Aaron Singh
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Travis Kotzur
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Beltran Torres-Izquierdo
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - David Momtaz
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Rishi Gonuguntla
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Amir Human Hoveidaei
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Ali Seifi
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - María Galán-Olleros
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| | - Pooya Hosseinzadeh
- From the UT Health San Antonio (Mr. Singh, Mr. Kotzur, Mr. Momtaz, Mr. Gonuguntla, and Dr. Seifi), Department of Orthopaedics, San Antonio, TX; the Washington University School of Medicine (Dr. Torres-Izquierdo, Dr. Hoveidaei, and Dr. Hosseinzadeh), Department of Orthopaedics, St. Louis, MO; and the Hospital Niño Jesus (Dr. Galán-Olleros), Department of Orthopaedics, Madrid, Spain
| |
Collapse
|
|
13
|
Momtaz D, Mirghaderi P, Gonuguntla R, Singh A, Mittal M, Burbano A, Hosseinzadeh P. Rate and Risk Factors for Contralateral Slippage in Adolescents Treated for Slipped Capital Femoral Epiphysis: A Comprehensive Analysis of 3,528 Cases. J Bone Joint Surg Am 2024; 106:517-524. [PMID: 38271486 DOI: 10.2106/jbjs.23.00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND After a unilateral slipped capital femoral epiphysis (SCFE), the contralateral hip is at risk for a subsequent SCFE. However, further information with regard to risk factors involved in the development of contralateral SCFE must be investigated. The purpose of this study was to report the rate and risk factors for subsequent contralateral SCFE in adolescents treated for unilateral SCFE by exploring a mix of known and potential risk factors. METHODS A case-control study utilizing aggregated multi-institutional electronic medical record data between January 2003 and March 2023 was conducted. Patients <18 years of age diagnosed with SCFE who underwent surgical management were included. Variables associated with contralateral SCFE were identified using multivariable logistic regression models that adjusted for patient characteristics and time of the surgical procedure, providing adjusted odds ratios (ORs). The false discovery rate was accounted for via the Benjamini-Hochberg method. RESULTS In this study, 15.3% of patients developed contralateral SCFE at a mean (and standard error) of 296.53 ± 17.23 days and a median of 190 days following the initial SCFE. Increased thyrotropin (OR, 1.43 [95% confidence interval (CI), 1.04 to 1.97]; p = 0.022), diabetes mellitus (OR, 1.67 [95% CI, 1.22 to 2.49]; p = 0.005), severe obesity (OR, 1.81 [95% CI, 1.56 to 2.57]; p < 0.001), history of human growth hormone use (OR, 1.85 [95% CI, 1.10 to 3.38]; p = 0.032), low vitamin D (OR, 5.75 [95% CI, 2.23 to 13.83]; p < 0.001), younger age in boys (under 12 years of age: OR, 1.85 [95% CI, 1.37 to 2.43]; p < 0.001) and in girls (under 11 years of age: OR, 1.47 [95% CI, 1.05 to 2.02]; p = 0.026), and tobacco exposure (OR, 2.43 [95% CI, 1.49 to 3.87]; p < 0.001) were significantly associated with increased odds of developing contralateral SCFE. CONCLUSIONS In the largest study on this topic, we identified the rate, odds, and risk factors associated with development of contralateral SCFE. We found younger age, hypothyroidism, severe obesity, low vitamin D, diabetes mellitus, and a history of human growth hormone use to be independent risk factors. Our findings can aid clinical decision-making in at-risk patients. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Peyman Mirghaderi
- Division of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Aaron Singh
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | | | - Andres Burbano
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| | - Pooya Hosseinzadeh
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
|
14
|
Aitken HD, Yen YM, Kiapour AM, Sailer WM, Holt JB, Goetz JE, Scott EJ. The Effects of Residual Femoral Deformity on Computed Contact Mechanics in Patients Treated With In Situ Fixation for Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2024; 44:e218-e225. [PMID: 38108380 DOI: 10.1097/bpo.0000000000002596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE In situ fixation for treatment of slipped capital femoral epiphysis (SCFE) can stabilize the epiphysis and prevent further joint deformation but often leaves residual deformity that may adversely affect intra-articular contact mechanics. The purpose of this study was to investigate the relationship between residual deformity and contact mechanics in the post-SCFE hip. METHODS Patient-specific hip models were created for 19 patients with SCFE treated with in situ fixation. For each model, discrete element analysis was used to compute cumulative acetabular and femoral contact stress exposure during a walking gait cycle. Slip severity was evaluated for each patient using the two-dimensional Southwick angle and a novel three-dimensional (3D) assessment of multiplanar femoral deformity (3D slip angle). RESULTS Of the SCFE cases, 2/7 mild (Southwick angle ≤30 degrees) had peak cumulative femoral exposures equivalent to that of severe (Southwick angle ≥60 degrees) cases. Severe SCFE cases had higher peak ( P = 0.015) and mean ( P = 0.028) femoral contact stress exposure and lower cumulative femoral contact area ( P = 0.003) than mild (Southwick angle ≤30 degrees) SCFE cases. Mean femoral contact stress exposure was also higher in severe SCFE cases than in moderate SCFE cases ( P = 0.027). Acetabular and femoral contact mechanics metrics typically demonstrated stronger correlations with 3D slip angle than two-dimensional Southwick angle. CONCLUSIONS Increased slip severity adversely impacts intra-articular femoral contact mechanics. Contact mechanics metrics demonstrate higher correlations with 3D slip angle, indicating that this novel measurement may better describe global deformity and its relationship to intra-articular mechanics; however, the modest strength of these correlations may also imply that global impingement-generating deformity is not the primary factor driving contact mechanics in the post-SCFE hip. CLINICAL RELEVANCE Greater slip severity adversely impacts contact mechanics in the post-SCFE hip. However, focal regions of high contact stress were seen even in mild SCFE deformities, suggesting some type of deformity correction should be considered even for mild slips to alleviate secondary impingement, address focal incongruities, and reduce osteoarthritis development/progression.
Collapse
Affiliation(s)
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA
| | | | | | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | | |
Collapse
|
|
15
|
Zusman NL, Goldstein RY, Yoo JU. Quantifying Risk Factors for Slipped Capital Femoral Epiphysis and Postslip Osteonecrosis. J Pediatr Orthop 2024; 44:e30-e34. [PMID: 37773028 DOI: 10.1097/bpo.0000000000002539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is a disorder of the proximal femoral physis occurring in late childhood and adolescence. Previously postulated risk factors include obesity and endocrinopathies. The purpose of this investigation was to identify risk factors for developing SCFE, as well as postslip osteonecrosis (ON), among the United States pediatric population. METHODS A national database investigation was performed using PearlDiver Technologies, Inc., queried for SCFE and ON using International Classification of Disease codes (2010 to 2020). Regression analyses to determine the risk of developing a SCFE, and ON after a patient has already been diagnosed with a SCFE ("postslip"). Propensity matching between SCFE and control groups generated a pseudo-randomization model to compare the relative risk. RESULTS There were 11,465 patients with SCFE available in the database, matched with 134,680 controls. After matching, vitamin D deficiency, obesity, hypothyroidism, and growth hormone use were risk factors for developing SCFE [relative risk ranges from 1.42 (95% CI: 1.21-1.39, vitamin D deficiency) to 3.45 (95% CI: 3.33-3.57, obesity)]. ON risk factors were vitamin D deficiency [1.65 (1.26-2.14)] and hypothyroidism [1.49 (1.10-2.07)]. CONCLUSIONS This United States national database study quantified risk factors of developing an SCFE and postslip ON. Obesity is the most significant risk factor for the development of a slip, but not ON. Growth hormone use, hypothyroidism, and vitamin D deficiency are also risk factors for SCFE development, whereas only the latter two were associated with ON. These findings demonstrate the public health implications of obesity and comorbid conditions in pediatric hip pathology. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Natalie L Zusman
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Rachel Y Goldstein
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jung U Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| |
Collapse
|
|
16
|
Moosabeiki V, de Winter N, Cruz Saldivar M, Leeflang MA, Witbreuk MMEH, Lagerburg V, Mirzaali MJ, Zadpoor AA. 3D printed patient-specific fixation plates for the treatment of slipped capital femoral epiphysis: Topology optimization vs. conventional design. J Mech Behav Biomed Mater 2023; 148:106173. [PMID: 37866280 DOI: 10.1016/j.jmbbm.2023.106173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
Orthopedic plates are commonly used after osteotomies for temporary fixation of bones. Patient-specific plates have recently emerged as a promising fixation device. However, it is unclear how various strategies used for the design of such plates perform in comparison with each other. Here, we compare the biomechanical performance of 3D printed patient-specific bone plates designed using conventional computer-aided design (CAD) techniques with those designed with the help of topology optimization (TO) algorithms, focusing on cases involving slipped capital femoral epiphysis (SCFE). We established a biomechanical testing protocol to experimentally assess the performance of the designed plates while measuring the full-field strain using digital image correlation. We also created an experimentally validated finite element model to analyze the performance of the plates under physiologically relevant loading conditions. The results indicated that the TO construct exhibited higher ultimate load and biomechanical performance as compared to the CAD construct, suggesting that TO is a viable approach for the design of such patient-specific bone plates. The TO plate also distributed stress more evenly over the screws, likely resulting in more durable constructs and improved anatomical conformity while reducing the risk of screw and plate failure during cyclic loading. Although differences existed between finite element analysis and experimental testing, this study demonstrated that finite element modelling can be used as a reliable method for evaluating and optimizing plates for SCFE patients. In addition to enhancing the mechanical performance of patient-specific fixation plates, the utilization of TO in plate design may also improve the surgical outcome and decrease the recovery time by reducing the plate and incision sizes.
Collapse
Affiliation(s)
- V Moosabeiki
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands.
| | - N de Winter
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands; Medical Physics, OLVG, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands
| | - M M E H Witbreuk
- Department of Orthopaedic Surgery, OLVG, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands
| | - V Lagerburg
- Medical Physics, OLVG, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628, CD, Delft, the Netherlands; Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| |
Collapse
|
|
17
|
Schlenzka T, Serlo J, Viljakka T, Tallroth K, Helenius I. In situ fixation of slipped capital femoral epiphysis carries a greater than 40% risk of later total hip arthroplasty during a long-term follow-up. Bone Joint J 2023; 105-B:1321-1326. [PMID: 38035599 DOI: 10.1302/0301-620x.105b12.bjj-2023-0148.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years. Methods In this study, 138 patients with 172 affected hips treated with in situ fixation were evaluated retrospectively. A total of 97 patients (70%) were male and the mean age was 13.6 years (SD 2.1); 35 patients (25%) had a bilateral disease. The median follow-up time was 49 years (interquartile range 43 to 55). Basic demographic, stability, and surgical details were obtained from patient records. Preoperative radiographs (slip angle; SA) were measured, and data on THA was gathered from the Finnish National Arthroplasty Register. Results The preoperative SA was a mean of 39° (SD 19°). At follow-up, 56 of the patients had undergone THA for a hip previously fixed in situ for SCFE (41%) and 64 of all affected hips had been replaced (37%). Kaplan-Meier analysis gave a median prosthesis-free postoperative survival of 55 years (95% confidence interval (CI) 45 to 64) for the affected hips. In a multivariate analysis, female patients had a two-fold risk for THA (hazard ratio (HR) 2.42 (95% CI 1.16 to 5.07)) and a greater preoperative SA increased the risk of THA (HR 1.03 for every increment of 1° (95% CI 1.01 to 1.05)), while patient age at surgery, slip laterality, stability of slip, or diagnostic delay did not have a statistically significant effect on the risk of THA. Conclusion SCFE treated primarily with in situ fixation may lead to THA in more than 40% of affected hips at a near 50-year follow-up. This risk is approximately 15-times the reported lifetime risk in the Finnish general population. Female sex and increasing preoperative SA significantly predicted higher risk of THA.
Collapse
Affiliation(s)
- Thomas Schlenzka
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joni Serlo
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
|
18
|
Ripatti L, Kauko T, Kytö V, Rautava P, Sipilä J, Lastikka M, Helenius I. The incidence and management of slipped capital femoral epiphysis: a population-based study. Acta Orthop Belg 2023; 89:634-638. [PMID: 38205753 DOI: 10.52628/89.4.9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku University Hospital patient charts were analyse for the incidence of SCFE in 2004-2012, the length of stay, and the type of surgery with respect to age, gender, study year, and season. The reoperations and rehospitalisations in 2004-2014 for SCFE were analysed for 2-10 years after surgery. In 2004 to 2012, primary surgery for SCFE was performed for 126 children. The average annual incidence of SCFE was 1.06/100 000 (95% confidence interval [CI], 0.81-1.38) in girls and 1.35/100 000 (95% CI 1.07-1.70) in boys. The median age at surgery was lower in girls than in boys (11 and 13 years, respectively, p<0.0001). During the study period, there was no significant change in the incidence of SCFE (p=0.9330), the type of primary procedures performed (p=0.9988), or the length of stay after the primary procedure (p=0.2396). However, the length of stay after percutaneous screw fixation was shorter compared with open reduction and fixation (mean 3.4 and 7.9 days, respectively, p<0.0001). There was no significant difference in the rate of reoperations according to the type of primary surgery. In conclusion, the incidence of SCFE and the proportion of different primary surgeries have recently remained stable in Finland.
Collapse
|
|
19
|
Heimkes B, Berger N, Frimberger V. [Clinical aspects of imaging the hip in infants, children and adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:715-721. [PMID: 37697155 DOI: 10.1007/s00117-023-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
When a child with a hip problem is clinically evaluated, it is usually possible to make a presumptive diagnosis which is subsequently confirmed. The most important tool for confirmation in pediatric hip disorders is radiological imaging. Vice versa changes on sonogram, native X‑ray or magnetic resonance images (MRI) can often only be interpreted when the history and current clinical findings are known. In this constellation, it is desirable that all colleagues who are confronted with a child's hip problem know the most common and important pediatric hip disorders and use the same terminology. The aim of this article is to present a short outline of the pathogenesis and clinical aspects of congenital and neurogenic hip dysplasia, coxitis fugax, septic coxitis, Perthes' disease, infantile and adolescent femoroacetabular impingement, apophysiolyses, and slipped capital femoral epiphysis.
Collapse
Affiliation(s)
- Bernhard Heimkes
- Sektion Kinder- und Neuroorthopädie, Klinik für Kinderchirurgie, Kliniken Dritter Orden gGmbH, Menzinger Str. 44, 80638, München, Deutschland.
| | - Nina Berger
- Sektion Kinder- und Neuroorthopädie, Klinik für Kinderchirurgie, Kliniken Dritter Orden gGmbH, Menzinger Str. 44, 80638, München, Deutschland
| | - Vincent Frimberger
- Sektion Kinder- und Neuroorthopädie, Klinik für Kinderchirurgie, Kliniken Dritter Orden gGmbH, Menzinger Str. 44, 80638, München, Deutschland
| |
Collapse
|
|
20
|
Fernandez J, Shim V, Schneider M, Choisne J, Handsfield G, Yeung T, Zhang J, Hunter P, Besier T. A Narrative Review of Personalized Musculoskeletal Modeling Using the Physiome and Musculoskeletal Atlas Projects. J Appl Biomech 2023; 39:304-317. [PMID: 37607721 DOI: 10.1123/jab.2023-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
In this narrative review, we explore developments in the field of computational musculoskeletal model personalization using the Physiome and Musculoskeletal Atlas Projects. Model geometry personalization; statistical shape modeling; and its impact on segmentation, classification, and model creation are explored. Examples include the trapeziometacarpal and tibiofemoral joints, Achilles tendon, gastrocnemius muscle, and pediatric lower limb bones. Finally, a more general approach to model personalization is discussed based on the idea of multiscale personalization called scaffolds.
Collapse
Affiliation(s)
- Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
- Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland,New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Marco Schneider
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Geoff Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Ted Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Ju Zhang
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Peter Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Thor Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
- Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland,New Zealand
| |
Collapse
|
|
21
|
Kwiatkowska M, Kwiatkowski M, Czubak-Wrzosek M, Czubak J, Tyrakowski M. Femoroacetabular impingement in the unpinned contralateral hip in patients with primary unilateral slipped capital femoral epiphysis: preliminary radiographic outcomes. J Pediatr Orthop B 2023; 32:236-240. [PMID: 35045005 DOI: 10.1097/bpb.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The study evaluated femoroacetabular impingement (FAI) in the unpinned contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) and verified initial age, posterior sloping angle (PSA) and center-edge angle (CEA) as predictors of FAI in the contralateral hip. 152 patients with unilateral SCFE with a mean index age of 13.2 years (8.2-17.2 years) were enrolled retrospectively into the study. Mean follow-up was 8 years (3-14 years). PSA and CEA were measured on initial radiographs of the unaffected hip. Alpha-angle and CEA were measured on radiographs taken at the last follow-up to identify FAI. Four groups of patients were distinguished: (1) no FAI (10 patients, 17.54%); (2) CAM-type FAI (41 patients, 71.9%); (3) pincer-type FAI (3 patients, 5.26%) and (4) mixed-type FAI (13 patients, 22.8%). The mean PSA was 12.1°, 12°, 16.8°, 11.9° for groups 1, 2, 3 and 4, respectively, with no significant difference ( P = 0.65). The mean initial CEA for groups 1, 2, 3 and 4 was 34.4°, 35.5°, 42° and 42° respectively, with significant differences between groups 1 versus 4 ( P = 0.034) and 2 versus 4 ( P = 0.009). Conclusions are as follows: 1. Radiographic features of FAI were present in 85.1% of unpinned contralateral hips in patients with unilateral SCFE. 2. 71.9% of unpinned contralateral hips developed CAM deformity. 3. CEA can be used in predicting pincer-type FAI in the contralateral hip in unilateral SCFE. 4. PSA and age revealed negligible value in predicting FAI.
Collapse
Affiliation(s)
- Magdalena Kwiatkowska
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education
| | - Marcin Kwiatkowski
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education
| | - Maria Czubak-Wrzosek
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego, Otwock, Poland
| | - Jarosław Czubak
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education
| | - Marcin Tyrakowski
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego, Otwock, Poland
| |
Collapse
|
|
22
|
Beharry AC, Quan Soon CH, Augustus M, Toby D, Thomas D. Increasing incidence of slipped capital femoral epiphysis in Trinidad and Tobago: A 50-year review. Trop Doct 2023; 53:85-90. [PMID: 36214270 DOI: 10.1177/00494755221130562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Slipped Capital Femoral Epiphysis (SCFE) is a physeal disorder of the proximal femur. Misdiagnosis and late treatment are associated with poorer outcomes. The epidemiology and delays in treatment of the disease between 1968 and 2018 were investigated in North Trinidad. The number of cases presenting annually has increased over the decades and the incidence between 2008-2018 was 2.2 cases per 100 000 per year. Almost 70% of cases were above the 95th percentile for body weight. Delay in treatment from onset of symptoms was 278 ± 258 days. Awareness of the risk factors and clinical presentation of SCFE may facilitate early diagnosis and treatment, and prevent severe hip disability in adulthood.
Collapse
Affiliation(s)
- Allan C Beharry
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad
| | - Camille H Quan Soon
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad.,Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad
| | - Megan Augustus
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad.,Department of Clinical Surgical Sciences, 37612The University of the West Indies, St Augustine, Trinidad
| | - David Toby
- Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad
| | - Dylan Thomas
- Princess Elizabeth Centre, Mucurapo, Port of Spain, Trinidad.,Department of Surgery, 63084San Fernando General Hospital, San Fernando, Trinidad
| |
Collapse
|
|
23
|
Cevallos N, Zukotynski B, Greig D, Silva M, Thompson RM. The Utility of Virtual Reality in Orthopedic Surgical Training. JOURNAL OF SURGICAL EDUCATION 2022; 79:1516-1525. [PMID: 35821110 PMCID: PMC10364838 DOI: 10.1016/j.jsurg.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/01/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the efficacy of virtual reality (VR) to prepare surgical trainees for a pediatric orthopedic surgery procedure: pinning of a slipped capital femoral epiphysis (SCFE). DESIGN Participants were randomly assigned to a standard, study guide (SG) group or to a VR training group. All participants were provided a technique video and SG; the VR group additionally trained via an Osso VR surgical trainer (ossovr.com) with real-time feedback and coaching from an attending pediatric orthopedic surgeon. Following training, participants performed a SCFE guidewire placement on a SawBones model embedded in a soft-tissue envelope (SawBones model 1161). Participants were asked to achieve "ideal placement" based on the training provided. Participants were evaluated on time, number of pin "in-and outs," penetration of the articular surface, angle between the pin and the physis, distance from pin tip to subchondral bone and distance from the center-center point of the epiphysis. SETTING Orthopedic Institute for Children, Los Angeles, CA. PARTICIPANTS Twenty fourth-year medical students, first- and second-year orthopedic residents without experience with the SCFE procedure. RESULTS Twenty participants were randomized to SG (n = 10) or VR (n = 10). Average time to final pin placement was 19% shorter in VR group (706 vs 573 seconds, p = 0.26). When compared to SG, the VR group had, on average, 70% less pin in-and-outs (1.7 vs 0.5, p = 0.28), 50% less articular surface penetrations (0.4 vs 0.2, p = 0.36), and 18% smaller distance from pin tip to subchondral bone on lateral view (7.1 vs 5.8 mm, p = 0.42). Moreover, the VR group had a lower average angle deviation between pin and line perpendicular to the physis on coronal view (4.9° vs 2.5°, p < 0.05). CONCLUSIONS VR training is potentially more effective than traditional preparatory methods. This pilot study suggests that VR training may be a viable surgical training tool, which may alleviate constraints of time, money, and safety concerns with resultant broad applicability for surgical education.
Collapse
Affiliation(s)
| | - Brian Zukotynski
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Danielle Greig
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mauricio Silva
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Orthopaedic Institute for Children, Los Angeles, California
| | - Rachel M Thompson
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Orthopaedic Institute for Children, Los Angeles, California.
| |
Collapse
|
|
24
|
Alvandi BA, Dayton SR, Hartwell MJ, Gerlach EB, Swiatek PR, Carney JJ, Tjong VK. Outcomes in Pediatric Hip FAI Surgery: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:362-368. [PMID: 35917094 PMCID: PMC9463420 DOI: 10.1007/s12178-022-09771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE OF REVIEW Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature. RECENT FINDINGS Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies-including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.
Collapse
Affiliation(s)
- Bejan A. Alvandi
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - Steven R. Dayton
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - Matthew J. Hartwell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - Erik B. Gerlach
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - Peter R. Swiatek
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - John J. Carney
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| | - Vehniah K. Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611 USA
| |
Collapse
|
|
25
|
DeVries CA, Badrinath R, Baird SG, Bomar JD, Upasani VV. Prospective evaluation of in situ screw fixation for stable slipped capital femoral epiphysis. J Child Orthop 2022; 16:385-392. [PMID: 36238141 PMCID: PMC9550994 DOI: 10.1177/18632521221118041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We aimed to determine which variables were associated with persistent symptoms or need for further surgery in patients treated with in situ fixation for stable slipped capital femoral epiphysis. We hypothesized that patients with greater proximal femoral deformity would require revision surgical intervention. METHODS We prospectively collected data on stable slipped capital femoral epiphysis patients who underwent in situ screw fixation at a single institution. Demographic and radiographic information, as well as patient-reported outcomes, were collected. RESULTS Forty-six patients (54 hips) with an average follow-up of 3.5 years (range: 2.0-8.5) and mean pre-op Southwick slip angle of 40.5° ± 19.4° were studied. We observed one complication following the index procedure (2%). Twelve hips (22%) went on to have a secondary procedure 2.7 ± 2.2 years after the index surgery. Severe slips were 14.8× more likely to undergo a secondary procedure than mild and moderate slips (p < 0.001). We found no correlation between slip severity and patient-reported outcomes (p > 0.6). Hips requiring a secondary procedure had significantly lower Hip disability and Osteoarthritis Outcome scores (76.8 ± 18.4) at final follow-up compared to hips that did not require additional surgery (86.8 ± 15.7) (p = 0.042). CONCLUSION With minimum 2-year follow-up, 22% of patients required a secondary surgery. Patient-reported outcomes did not correlate with slip severity, but were found to be significantly higher in slipped capital femoral epiphysis patients that did not require a secondary procedure. Prophylactic treatment of all slip-related cam deformity was not found to be necessary in this prospective cohort. Patients with moderate-to-severe slips may require secondary surgery. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
| | - Raghav Badrinath
- San Diego Medical Center, University of California, San Diego, San Diego, CA, USA
| | - Samuel G Baird
- San Diego Medical Center, University of California, San Diego, San Diego, CA, USA
| | - James D Bomar
- Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Vidyadhar V Upasani
- San Diego Medical Center, University of California, San Diego, San Diego, CA, USA,Rady Children’s Hospital-San Diego, San Diego, CA, USA,Vidyadhar V Upasani, Rady Children’s Hospital-San Diego, 3020 Children’s Way, MC5062, San Diego, CA 92123, USA.
| |
Collapse
|
|
26
|
Wang J, Kokinos BP, Lang PJ, Crenshaw TD, Henak CR. Vitamin D deficiency and anatomical region alters porcine growth plate properties. J Biomech 2022; 144:111314. [PMID: 36182792 DOI: 10.1016/j.jbiomech.2022.111314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
Ossification of growth plate cartilage mediates longitudinal extension of long bones. Biomechanical and biochemical disruptions of growth plate function may lead to abnormal bone growth. In humans and animals, severe dietary vitamin D deficiency can lead to rickets which features growth plate widening, resulting in abnormalities in growth. However, effects of marginal vitamin D deficiencies on growth plates are not well understood. The purpose of this study was to examine the effects of a vitamin D deficient diet in the 26-day nursery phase on mechanical properties (ultimate normal stress, ultimate shear stress, ultimate strain, and tangent modulus) of porcine growth plate. Standard uniaxial tensile tests were applied on bone-growth plate-bone sections and the total stress was decomposed into normal stress and shear stress. Ultimate shear stress and ultimate strain traits were lower in the vitamin D deficient group than in the control. Regional differences were observed in all four variables. Ultimate normal stress was higher in the anterior region, which was consistent with a previous study. Sex differences were detected in ultimate normal stress, which was higher in females than in males. Interestingly, the classical finding of growth plate widening seen in severe vitamin D deficiency was not observed in the pigs with marginal vitamin D deficiency utilized in this study.
Collapse
Affiliation(s)
- Jingyi Wang
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittney P Kokinos
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Pamela J Lang
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States
| | - Thomas D Crenshaw
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Corinne R Henak
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States.
| |
Collapse
|
|
27
|
The Effect of the Type of Screw Fixation Used in the Treatment of Slipped Capital Femoral Epiphysis. Adv Orthop 2022; 2022:9143601. [PMID: 36249569 PMCID: PMC9553714 DOI: 10.1155/2022/9143601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Slipped capital femoral epiphysis (SCFE) remains among the most common hip disorders in the adolescent population. The management of SCFE remains controversial; however, the aim of fixation is to stabilize the physis and prevent further slippage. In situ fixation remains the gold standard; however, in the young population, it can lead to reduced femoral neck growth and complications such as leg length discrepancies. The ideal form of in situ fixation for mild to moderate SCFE would stabilize the slip and allow continued proximal femoral growth. This study aimed to determine if partially threaded screws allowed more neck growth than fully threaded screws. Methods A retrospective review of the radiographs of all patients undergoing in situ fixation for SCFE using partially threaded and fully threaded screws. Measurements included neck length, neck-to-screw ratio, neck shaft angle, neck width, and articular-trochanteric distance. Parameters were compared over a two-year period to determine whether there was any difference in proximal femoral growth between the two types of screws. Results Fully threaded screw neck length increased by 5 mm versus 5 mm for proximally threaded screws (P ≤ 0.001). No significant difference was observed between the two groups with respect to neck width, neck shaft angle, and articular-trochanteric distance. Conclusions No difference was observed in proximal femoral growth. Regardless of which type of fixation is used, neck length continues to increase by approximately 3 mm per year.
Collapse
|
|
28
|
Veramuthu V, Munajat I, Islam MA, Mohd EF, Sulaiman AR. Prevalence of Avascular Necrosis Following Surgical Treatments in Unstable Slipped Capital Femoral Epiphysis (SCFE): A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1374. [PMID: 36138683 PMCID: PMC9497816 DOI: 10.3390/children9091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
The choice of treatment for unstable and severely displaced slipped capital femoral epiphysis (SCFE) is controversial. This meta-analysis was conducted to determine the prevalence of femoral head avascular necrosis (AVN) following various treatments for unstable SCFE. Various databases were searched to identify articles published until 4 February 2022. A random-effects model was used to examine prevalence as well as risk ratios with confidence intervals (CIs) of 95%. Thirty-three articles were analyzed in this study. The pooled prevalences of AVN in pinning in situ, pinning following intentional closed reduction, pinning following unintentional closed reduction, and open reduction via the Parsch method, subcapital osteotomy and the modified Dunn procedure were 18.5%, 23.0%, 27.6%, 9.9%, 18.6% and 19.9%, respectively. The risk of developing AVN in pinning following intentional closed reduction was found to be 1.62 times higher than pinning in situ; however, this result was not significant. The prevalence of AVN in open reduction was lowest when performed via the Parsch method; however, this finding should be interpreted with caution, since the majority of slips so-treated are of mild and moderate types as compared with the subcapital osteotomy and modified Dunn procedures, which are predominantly used to treat severely displaced slips. As the risk ratio between intentional closed reduction and the modified Dunn method showed no significant difference, we believe that the modified Dunn method has the advantage of meticulously preserving periosteal blood flow to the epiphysis, thus minimizing AVN risk. In comparison with intentional closed reduction, the modified Dunn method is used predominantly in cases of severe slips.
Collapse
Affiliation(s)
- Vijayanagan Veramuthu
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Munajat
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Emil Fazliq Mohd
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Abdul Razak Sulaiman
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| |
Collapse
|
|
29
|
Hardware Impingement Is Associated With Shorter Screw Length in Patients Treated With In Situ Screw Fixation for Slipped Capital Femoral Epiphysis: An In Vivo Arthroscopic Evaluation. Arthrosc Sports Med Rehabil 2022; 4:e1623-e1628. [PMID: 36312729 PMCID: PMC9596863 DOI: 10.1016/j.asmr.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
Collapse
|
|
30
|
Valenza W, Soni J, Przysiada L, Faggion H. Necrose avascular pós-cirurgia de Dunn modificada no tratamento do escorregamento da epífise proximal do fêmur*. Rev Bras Ortop 2022; 57:807-814. [PMID: 36226215 PMCID: PMC9550365 DOI: 10.1055/s-0042-1744499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objective
The present study analyzed the incidence of epiphyseal avascular necrosis in patients with slipped capital femoral epiphysis (SCFE) treated using a modified Dunn technique. In addition, this study determined the correlation of other variables with this incidence and described treatment complications.
Methods
This is a retrospective study with 20 patients treated by the same surgical team from 2009 to 2019 and followed up for 2 to 12 years. The analysis included general features, time from presentation to surgical procedure, classification, and intraoperative blood perfusion of the epiphysis, as well as complications and their treatment.
Results
All cases were severe; 65% were acute on chronic, and 55% of the SCFEs were unstable. Our complication rate was 45%, with 5 cases of avascular necrosis, 2 cases of deep infection, 1 case of material failure, and 1 case of joint instability. The statistical analysis revealed that the risk of necrosis was higher when the surgery occurred after a long hospitalization time and there was no intraoperative epiphyseal perfusion. Four necrosis cases happened within the first 5 years, and 1 case in the last 5 years of the study.
Conclusion
Our study showed that necrosis was the most common complication. It also revealed that surgery delay and lack of intraoperative epiphysis perfusion potentially predispose to avascular necrosis. Although with no statistical significance, coxofemoral instability occurred in chronic SCFE, and surgical fixation with threaded wires was less effective than fixation with a cannulated screw.
The modified Dunn procedure should be reserved for severe cases in which other techniques are not feasible and performed by an experienced, trained, and qualified team.
Collapse
Affiliation(s)
- Weverley Valenza
- Departamento de Ortopedia e Traumatologia do Hospital do Trabalhador, Curitiba, PR, Brasil
| | - Jamil Soni
- Departamento de Ortopedia e Traumatologia do Hospital do Trabalhador, Curitiba, PR, Brasil
| | - Laís Przysiada
- Departamento de Ortopedia e Traumatologia do Hospital do Trabalhador, Curitiba, PR, Brasil
| | - Heloísa Faggion
- Departamento de Ortopedia e Traumatologia do Hospital do Trabalhador, Curitiba, PR, Brasil
| |
Collapse
|
|
31
|
Vink SJC, van Stralen RA, Moerman S, van Bergen CJA. Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable: A systematic review. World J Orthop 2022; 13:515-527. [PMID: 35633749 PMCID: PMC9124999 DOI: 10.5312/wjo.v13.i5.515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) occurs in adolescents and has an incidence of around 10 per 100000 children. Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population. Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient, an underlying endocrine disorder, growth hormone use and a higher radiographic posterior sloping angle. However, there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient. AIM To investigate the risk rate of contralateral SCFE and assess the (dis)advantages of prophylactic fixation of the contralateral hip. METHODS A systematic literature search was performed in the Embase, Medline, Web of Science Core Collection and Cochrane databases. Search terms included 'slipped capital femoral epiphysis,' 'fixation,' 'contralateral,' and derivatives. The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing. Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side, or about the rates of contralateral slips and complications thereof. The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria. RESULTS Of 293 identified unique publications, we included 26 studies with a total of 12897 patients. 1762 patients (14%) developed a subsequent symptomatic contralateral slip. In addition, 38% of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms. The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an (asymptomatic) slip, thus reducing the increased risk of avascular necrosis (AVN), cam morphology and osteoarthritis. Disadvantages include an increased risk of infection, AVN, peri-implant fractures, loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance. These risks, however, appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE. CONCLUSION The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages. The final decision for treatment remains to be patient-tailored.
Collapse
Affiliation(s)
- Steven J C Vink
- Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam 3015GD, Netherlands
| | - Renée A van Stralen
- Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam 3015GD, Netherlands
| | - Sophie Moerman
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen 9713GZ, Netherlands
| | | |
Collapse
|
|
32
|
Makarewich CA, Wait ES, Fedorak GT, MacWilliams BA. Factors Affecting Slip Progression After In Situ Screw Fixation of Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2022; 42:e414-e420. [PMID: 35200211 DOI: 10.1097/bpo.0000000000002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Slip progression after in situ fixation of slipped capital femoral epiphysis (SCFE) has been reported as occurring in up to 20% of patients. We review SCFE treated with in situ single screw fixation performed at 2 hospitals over a 15-year period to determine the factors associated with slip progression. METHODS This case-control study reviews SCFE treated with in situ single cannulated screw fixation with minimum follow up of 1 year and full closure of the affected physis. Slip progression (failure) was defined as worsening of the Southwick slip angle of 10 or more degrees or revision surgery for symptomatic slip progression. Univariate and multivariate analyses were performed comparing success and failure groups for patient characteristics, screw type and position, and radiographic measurements. RESULTS Ninety three patients with 108 slips met all criteria, with 15 hips (14%) classified as having slip progression (failure). All failures had 3 threads or fewer across the physis. Five hips had 2 threads across the physis, and 4 of the 5 were classified as failures. Lower modified Oxford bone scores were found in the failure group, though the difference was small (0.9, P=0.013). Failure was also associated with partially threaded screws (P=0.001). Failed hips were associated with lower initial Southwick angles (32.8 degrees) than successful hips (40.4 degrees) (P=0.047). In the stepwise model for multivariate regression, 4 factors were identified as significant, with lower initial number of threads (P<0.0001), mild initial Southwick category (P=0.0050), male sex (P=0.0061), and partially threaded screw type (P=0.0116) predicting failure. CONCLUSION This study is the largest to date evaluating risk factors for slip progression after SCFE fixation, and the first to consider revision surgery for symptomatic slip progression. For stable SCFE, we demonstrate that 4 threads across the physis with a fully threaded screw of 6.5 mm diameter or greater was sufficient to avoid slip progression. We provide a risk stratification for progression of slip showing that in some cases 3 threads across the physis may be sufficient. LEVEL OF EVIDENCE Level III-case-control study.
Collapse
Affiliation(s)
- Christopher A Makarewich
- Department of Orthopaedics, University of Utah.,Primary Children's Hospital.,Shriners Children's, Salt Lake City, UT
| | - Eric S Wait
- Department of Orthopaedics, University of Utah.,Primary Children's Hospital.,Shriners Children's, Salt Lake City, UT
| | - Graham T Fedorak
- Department of Orthopaedics, University of Utah.,Primary Children's Hospital.,Shriners Children's, Salt Lake City, UT
| | - Bruce A MacWilliams
- Department of Orthopaedics, University of Utah.,Shriners Children's, Salt Lake City, UT
| |
Collapse
|
|
33
|
Hansen CH, Bomar JD, Badrinath R, Upasani VV. Telescoping screw fixation compared to traditional in situ screw fixation for slipped capital femoral epiphysis: clinical, radiographic and patient-reported outcomes. J Pediatr Orthop B 2022; 31:224-231. [PMID: 34050119 DOI: 10.1097/bpb.0000000000000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compares clinical, radiographic and patient-reported outcomes among telescoping and traditional screws for the treatment of slipped capital femoral epiphysis (SCFE). We hypothesized that telescoping screws would prevent slip progression and result in preserved femoral neck growth and improved patient-reported outcomes. Traditional screws were compared to telescoping screws in a 2:1 matched cohort based on age at initial surgery, length of radiographic follow-up and whether or not the hip was pinned prophylactically or as a treatment for SCFE. Neck length and telescoping screw length were measured. The patient-reported outcomes were obtained at routine clinic visits. Total 42 hips were included with a mean follow-up of 24.5 ± 3.3 months. No patients developed avascular necrosis, chondrolysis or needed revision surgical procedures. Telescoping screws increased in length for the entire cohort by a mean of 6.0 ± 4.3 mm. Neck length change was not different in SCFE hips when treated with traditional screws vs. telescoping screws (P = 0.527). However, there was a difference in neck length change between the two groups when comparing prophylactically treated hips (P = 0.001). There were no significant differences in patient-reported outcomes among hips treated with telescoping screws compared to traditional screws. Traditional and telescoping screws are both effective for the treatment of SCFE. Telescoping screws have an advantage when prophylactically treating hips that are at risk of slipping as they don't lead to the coxa breva that is seen with traditional screws. However, both treatment methods had similar patient-reported outcomes.
Collapse
Affiliation(s)
- Cody H Hansen
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
| | - James D Bomar
- Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA
| | - Raghav Badrinath
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
| | - Vidyadhar V Upasani
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
- Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
|
34
|
Castillo Tafur JC, Furdock RJ, Sattar A, Liu RW. The Optimized Oxford Hip Skeletal Maturity System Proves Resilient to Rotational Variation. J Pediatr Orthop 2022; 42:186-189. [PMID: 35089879 DOI: 10.1097/bpo.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The recently described optimized Oxford skeletal maturity system utilizes anteroposterior (AP) hip radiographs to accurately, rapidly, and reliably estimate skeletal maturity. However, in the real-world setting, significant positional variation in AP hip radiographs may influence the accuracy of optimized Oxford skeletal age estimates. We sought to evaluate the consistency of skeletal age estimations using the optimized Oxford system between differently rotated radiographs. METHODS Thirty normal computerized tomography scans of males (15 children, 9 to 15 y) and females (15 children, 8 to 14 y) were obtained retrospectively, converted into 3D reconstructions, and then used to produce simulated hip radiographs in five different rotational positions. The optimized Oxford system was applied to the 150 simulated AP hip radiographs (5 differently rotated views of 30 hips) to produce a skeletal age estimate for each. RESULTS Rotational position did not have a statistically significant effect on the skeletal age (P=0.84) using 1-way repeated measures analysis of variance. Of the 5 radiographic parameters in the optimized Oxford system, only greater trochanter height showed significant rotational variation after Greenhouse-Geisser correction (F2.58, 74.68=5.98, P<0.001). However, post hoc analyses showed that the greater trochanter height obtained at the most centered position was not different from the other 4 rotational positions (P>0.05 for all). CONCLUSION The optimized Oxford skeletal maturity system is resilient to rotational variation. Mildly to moderately rotated radiographs obtained in the modern clinical setting can be used for skeletal age estimation by this method, broadening the clinical usage of this system. LEVEL OF EVIDENCE Level III-diagnostic study.
Collapse
Affiliation(s)
- Julio C Castillo Tafur
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Abdus Sattar
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Raymond W Liu
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| |
Collapse
|
|
35
|
Niu Z, Tang J, Shen X, Xu S, Zhou Z, Liu T, Zuo J. Slipped capital femoral epiphysis with hypopituitarism in adults: A case report and literature review. Medicine (Baltimore) 2021; 100:e28256. [PMID: 34941101 PMCID: PMC8702267 DOI: 10.1097/md.0000000000028256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Slipped capital femoral epiphysis (SCFE) is a common disease in pediatric orthopedics. Most research on SCFE has focused on high-risk groups or the whole population, and studies focusing on adult SCFE patients are rare. In the present study, we report the case of an adult patient with SCFE. PATIENT CONCERN A 37-year-old man presented to our clinic with persistent pain that was poorly localized to both hips, groin regions, and thighs for more than 1 year. DIAGNOSES A bilateral hip X-ray examination was performed, and the femoral epiphyses were found to be unfused on both sides. Low levels of growth hormone (GH), insulin-like growth factor-1 (IGF-1), triiodothyronine (T3), thyroxine (T4), follicle-stimulating hormone, luteinizing hormone, estradiol, and testosterone, and high levels of thyroid-stimulating hormone, prolactin, and cortisol. INTERVENTIONS Hormone-substitution therapies (levothyroxine sodium to treat hypothyroidism and testosterone enanthate to treat hypogonadism) were prescribed. Total hip arthroplasty was performed to treat femoral epiphysis slippage. OUTCOMES After 6 months of postoperative follow-up, the patient's gait improved significantly, and bilateral hip pain was relieved. LESSONS When treating adults with SCFE, clinicians must be alert to endocrine disorders. Comprehensive imaging evaluation is crucial for the accurate diagnosis and selection of an appropriate treatment.
Collapse
Affiliation(s)
- Zhixin Niu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinshuo Tang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xianyue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Shenghao Xu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongsheng Zhou
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
|
36
|
Levey ST, Goodloe JB, Murphy RF, Van Nortwick S. Mechanical Failure of 2 Cannulated Screw Fixation for Unstable SCFE: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00076. [PMID: 34910713 DOI: 10.2106/jbjs.cc.21.00501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old obese boy presented with an acute-on-chronic unstable left slipped capital femoral epiphysis (SCFE). He underwent in situ surgical fixation with two 6.5-mm fully threaded cannulated screws. At 6 months, he presented with mechanical failure of both screws. He underwent screw removal, revision in situ fixation, a peritrochanteric flexion and internal rotational osteotomy, and an open femoroplasty. The osteotomy healed at 6 weeks. The femoral physis took an additional year to close. CONCLUSION This case highlights an uncommon complication of in situ pinning of SCFE, discusses revision fixation options, and suggests possible prolonged physeal closure in severe slips.
Collapse
Affiliation(s)
- Sarah Toner Levey
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana
| | - J Brett Goodloe
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
| | - Robert F Murphy
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
| | - Sara Van Nortwick
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
| |
Collapse
|
|
37
|
Novel Application of Immersive Virtual Reality Simulation Training: A Case Report. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202111000-00009. [PMID: 34807871 PMCID: PMC8604004 DOI: 10.5435/jaaosglobal-d-21-00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022]
Abstract
Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of immersive virtual reality (iVR) training. This case report documents the first reported example of an immediate translation of surgical skill from iVR to the operating room. Conclusion: There is increasing evidence for the use of iVR in orthopaedic education. Several randomized controlled trials demonstrate improved trainee performance relative to control when measured in analogous operating room assessments. This is the first case report demonstrating direct patient care after the use of iVR. The implications of cost-effectiveness through skill transfer and patient safety are highlighted.
Collapse
|
|
38
|
Moran TE, Taleghani ER, Gwathmey FW. Arthroscopic Treatment of Iatrogenic Slipped Capital Femoral Epiphysis Screw Impingement and Associated Hip Pathology. VIDEO JOURNAL OF SPORTS MEDICINE 2021; 1:26350254211025033. [PMID: 40308277 PMCID: PMC11887893 DOI: 10.1177/26350254211025033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 05/02/2025]
Abstract
Background Screw impingement is an infrequently reported sequelae following in situ pinning of a slipped capital femoral epiphysis, but it may result in significant bony and chondrolabral degeneration. Hip arthroscopy may offer the advantage of screw removal in a minimally invasive manner under direct visualization, as well as providing the opportunity for management of concomitant hip pathology. Indications A healthy, active 27-year-old woman with right hip dysfunction secondary to screw impingement and concomitant chondrolabral pathology following previous in situ pinning of a slipped capital femoral epiphysis. Technique Description The patient elected to undergo arthroscopic removal of hardware, osteochondroplasty, and management of hip labrum pathology. After the screw was localized, a 2.8-mm pin was inserted down the cannulated center of the screw to prevent intraarticular displacement during removal. The screw and washer were removed intact, and femoroplasty was performed to remove the reactive bone and resolve the cam-type impingement. Acetabuloplasty was then performed to remove pincer-type impingement and provide an appropriate rim of bone for labral reconstruction. The pathologic labrum was then debrided and reconstructed with a semitendinosus allograft. Results There were no immediate complications following surgery. Surgical management led to resolution of the patient's mechanical symptoms and provided pain relief, which allowed return to prior baseline level of function. Discussion/Conclusion Symptomatic screws that impinge the osteochondral and soft tissue anatomy of the hip require removal. Historically, these screws have been removed by open, mini-open, or percutaneous techniques. This case demonstrates the advantages of arthroscopic removal, as it affords the surgeon the ability to perform a dynamic examination, safely remove the screw, and directly visualize and manage concomitant hip pathology that may not be otherwise be recognizable. Further studies will be required to determine the ability of this technique to more clearly illustrate long-term improvement in function and prevention of the development of osteoarthritis.
Collapse
Affiliation(s)
- Thomas E. Moran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Eric R. Taleghani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
|
39
|
Cazzulino A, Wu W, Allahabadi S, Swarup I. Diagnosis and Management of Unstable Slipped Capital Femoral Epiphysis: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202107000-00007. [PMID: 34270502 DOI: 10.2106/jbjs.rvw.20.00268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» An unstable slipped capital femoral epiphysis (SCFE) is characterized by the inability to walk and is associated with a high risk of osteonecrosis. » An unstable SCFE is less common than a stable SCFE; however, the demographics are similar in both groups of patients with SCFE. » The diagnosis of an unstable SCFE is characterized by a history of antecedent pain and the inability to walk on examination, and it is confirmed by radiographic assessment. » Management of an unstable SCFE includes closed reduction, open reduction, and capital realignment, which have all been noted to have lower rates of osteonecrosis than reported in historic reports. » All management approaches have certain advantages and disadvantages, and comparative studies are needed to guide clinical decision-making.
Collapse
Affiliation(s)
- Alejandro Cazzulino
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California
| | - Wei Wu
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Sachin Allahabadi
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California
| | - Ishaan Swarup
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, University of California San Francisco, Oakland, California
| |
Collapse
|
|
40
|
Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2021; 41:e309-e315. [PMID: 33560709 DOI: 10.1097/bpo.0000000000001770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of stable slipped capital femoral epiphysis (SCFE) most commonly involves in situ fixation with a standard cannulated screw, leading to physeal arrest. Recently, Pega Medical (Laval, Canada) introduced the free-gliding (FG) SCFE screw, which employs a growth-friendly, telescopic design. This study examines femoral neck growth and remodeling over the first 2 postoperative years in stable SCFE treated with FG versus standard screws. METHODS We retrospectively reviewed 32 hips (19 SCFE, 13 prophylactic) in 16 patients treated with FG screws for stable SCFE. We also reviewed 102 hips (63 SCFE, 19 prophylactic, 20 controls) in 55 patients treated with standard screws. Immediate postoperative radiographs were compared with 1- and 2-year follow-up images. RESULTS For the overall study cohort, mean age at surgery was 12.2±1.9 years, with a mean slip angle of 26.9±18.0 degrees. In FG SCFE hips, the alpha angle remodeled 12.9±19.2 degrees in the first postoperative year (P=0.018) and articulotrochanteric distance decreased by 4.2±4.6 mm at 2 years (P=0.018). In standard SCFE hips, the alpha angle remodeled 4.3±11.3 degrees at 1 year (P=0.014), while articulotrochanteric distance decreased by 4.5±3.2 mm at 2 years (P<0.001). By 2 years, FG screws lengthened more in prophylactic (4.8±3.4 mm) than SCFE hips (1.7±1.8 mm, P=0.027). CONCLUSIONS Greater remodeling of femoral neck cam deformity occurs when treating SCFE using an FG screw. Further research is required to measure the impact of this finding on femoroacetabular impingement and degenerative arthritis. In addition, FG screws allow ongoing growth of prophylactically treated hips, while standard screws promote coxa breva. LEVEL OF EVIDENCE Level III-retrospective comparative, therapeutic study.
Collapse
|
|
41
|
Harris JB, Sunil B, Ryan MK, Beauchamp G. Association of Slipped Capital Femoral Epiphysis With Panhypopituitarism Due to Pituitary Macroadenoma: A Case Report. J Investig Med High Impact Case Rep 2021; 9:2324709621999956. [PMID: 33783256 PMCID: PMC8013885 DOI: 10.1177/2324709621999956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Slipped capital femoral epiphysis (SCFE) commonly occurs in overweight or obese adolescents, but can also be associated with endocrine disorders including hypothyroidism, pituitary tumors, and growth hormone deficiency. In this article, we present a case of panhypopituitarism that initially presented with SCFE. A 16-year-old male presented with right SCFE. After a right hip open reduction and percutaneous pinning procedure, findings of skeletal maturity that lagged behind his chronologic age and a delayed Tanner stage resulted in a referral to an endocrine specialist. Endocrine laboratory evaluation identified elevated prolactin levels (1493 ng/mL), hypogonadotropic hypogonadism, and central adrenal insufficiency as evidenced by low morning cortisol level of 1.0 µg/dL. Magnetic resonance imaging revealed a large pituitary T2 isointense mass measuring 1.8 × 2.7 × 2.3 cm. The patient was diagnosed with panhypopituitarism due to a pituitary macroadenoma. Multidisciplinary collaboration for treatment of this patient consisted of oral cabergoline, oral levothyroxine, oral hydrocortisone therapy, intramuscular testosterone therapy, and a prophylactic closed reduction percutaneous pinning of the left hip due to high risk of also developing SCFE of the left hip. Panhypopituitarism should be considered as a diagnosis after atypical presentations of SCFE. In our case, an astute clinical assessment resulted in prompt endocrine referral and management of panhypopituitarism. Our report highlights the importance of multidisciplinary collaborations to guarantee early detection of endocrinopathies in patients with SCFE undergoing surgical interventions in order to avoid potential complications, such as adrenal crisis during surgery.
Collapse
Affiliation(s)
| | | | - Michael K Ryan
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, AL, USA
| | | |
Collapse
|
|
42
|
Abstract
Valgus slipped capital femoral epiphysis (SCFE) is a rare entity which leads to a proximolateral displacement of the hip epiphysis. The literature on valgus SCFE consists of case reports or case series. Since no evidence synthesis has been conducted, a systematic review on all published cases of valgus SCFE was conducted. The search strategy located 27 studies comprising 74 subjects with 96 hips. Demographic results were as follows: female/male ratio was of 1.65, and the mean age at presentation was 13.0 ± 2.54 years. Bilateral cases were recorded in 31.1%. Hip pain was the most frequent symptom followed by limping. The most frequent clinical sign was the limitation of medial internal rotation. Comorbidities were present in 65.6% of patients, mostly as endocrine or metabolic disorders. The mean neck-shaft angle was 149.2 ± 9.2°, the mean physis-shaft angle was 83.3 ± 9.7°, the neck-physis angle was 36.1 ± 21.5°, and the posterior physeal tilt angle was 23 ± 6.07°. The physeal tilt was lateral in 90% of cases. Treatment was based on screws in 70.8% of cases, a femoral osteotomy in 18.75%, and the remaining had a combination of surgical procedures. Two out of the three screw migrations occurred following fixation with more than one screw. All major complications (8.3%) had the potential of developing osteoarthritis in the future. Valgus SCFE entity demonstrates distinctive demographic, clinical and radiological results. This rare entity should be always included in the differential diagnosis of hip pain or limping in children.
Collapse
|
|
43
|
Ghijselings S, Touquet J, Himpe N, Simon JP, Corten K, Moens P. Degenerative changes of the hip following in situ fixation for slipped capital femoral epiphysis: a minimum 18-year follow-up study. Hip Int 2021; 31:264-271. [PMID: 31379207 DOI: 10.1177/1120700019867248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In situ fixation (ISF) is currently still the 'gold standard' treatment for slipped capital femoral epiphysis (SCFE) and has shown acceptable results at mid-term follow-up. This study aims to evaluate functional, clinical and radiographic long-term outcomes after this procedure. METHODS We reviewed 64 SCFE patients (76 SCFE hips) treated with ISF between 1983 and 1998. 82.9% were stable hips and 17.1% unstable according to Loder's definition. Initial radiographs demonstrated a mild slip in 50%, moderate in 41.3% and severe in 8.7% based on the Southwick angle. Long-term outcomes were assessed using the modified Harris Hip Score (mHHS), University of California at Los Angeles (UCLA) and Tegner activity scores, visual analogue scale (VAS) pain, VAS function, flexion-adduction-internal rotation (FADIR) test, extent of internal-rotation at 90° of hip flexion and Tönnis classification for hip osteoarthritis (OA). RESULTS 10 (15.6%) SCFE hips were converted to a total hip replacement (THR) after a mean of 16 years. 38 (59.4%) patients underwent a clinical and radiographic examination after a mean follow-up of 23 (range 18-33) years. 12 (18.8%) patients were lost to follow-up. 74% of SCFE hips demonstrated degenerative change on radiography or were converted to THR (Tönnis 1: 33.3%, 2: 18.5%, 3 or THR: 22.2%). There were 3 cases of avascular necrosis (AVN) all in unstable hips. Mean mHHS was 86.8/100, UCLA activity score 7.5/10, Tegner activity score 3.8/10, VAS pain 1.7/10 and VAS function 1.5/10. 20% of SCFE hips were found to have a positive FADIR-test and a limited internal-rotation of 19.7° versus 36.1° (p < 0.001) in contralateral normal hips. DISCUSSION This long-term follow-up study of ISF for SCFE shows that although complication rates in terms of AVN are low, a high number of patients become symptomatic and have a limited function. Degenerative changes are common with 22.2% of hips developing end-stage hip OA (Tönnis 3 or THR). It is important that patients and parents are informed about these risks.
Collapse
Affiliation(s)
- Stijn Ghijselings
- Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium
| | - Jeroen Touquet
- Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium
| | - Nicolas Himpe
- Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium
| | - Jean-Pierre Simon
- Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium
| | | | - Pierre Moens
- Orthopaedic Department, University Hospitals Leuven - Pellenberg, Belgium
| |
Collapse
|
|
44
|
Besomi J, Escobar V, Alvarez S, Valderrama J, Lopez J, Mella C, Lara J, Meneses C. Hip arthroscopy following slipped capital femoral epiphysis fixation: chondral damage and labral tears findings. J Child Orthop 2021; 15:24-34. [PMID: 33643455 PMCID: PMC7907763 DOI: 10.1302/1863-2548.15.200178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). METHODS This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. RESULTS We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. CONCLUSION A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Javier Besomi
- Pediatric Orthopaedic Surgery Unit, Orthopaedic Surgery Department and Urgencia Escolar Clinica Alemana de Santiago/Facultad de Medicina Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
- Pediatric Orthopaedic Surgery Service Hospital Clinico San Borja Arriaran, Santiago, Chile
- Hip and Pelvis Unit, Orthopaedic Surgery Department Clinica Alemana de Santiago – Chile / Facultad de Medicina Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Valeria Escobar
- Pediatric Orthopaedic Surgery Service Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Santiago Alvarez
- Pediatric Orthopaedic Surgery Service Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Juanjose Valderrama
- Knee Surgery Unit, Department of Orthopaedic Surgery Hospital Clinico Mutual de Seguridad and Department of Orthopaedic Surgery Clinica Indisa, Santiago, Chile
| | - Jaime Lopez
- Hip and Pelvis Unit, Orthopaedic Surgery Department Clinica Alemana de Santiago – Chile / Facultad de Medicina Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Claudio Mella
- Hip and Pelvis Unit, Orthopaedic Surgery Department Clinica Alemana de Santiago – Chile / Facultad de Medicina Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
| | | | - Claudio Meneses
- Pediatric Orthopaedic Surgery Unit, Orthopaedic Surgery Department and Urgencia Escolar Clinica Alemana de Santiago/Facultad de Medicina Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
- Pediatric Orthopaedic Surgery Service Hospital Clinico San Borja Arriaran, Santiago, Chile
| |
Collapse
|
|
45
|
Abstract
Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described:
(1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’). Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results. Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074
Collapse
Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
|
46
|
Abstract
BACKGROUND The New Zealand Māori and Pacific ethnicities have the highest burden of slipped capital femoral epiphysis (SCFE) worldwide. Therefore, New Zealand provides a rich and unique therapeutic and research environment for this devastating hip condition. METHODS A systematic literature review was performed using MEDLINE, PubMed, and Google Scholar from January 1, 1900, to December 31, 2019, with the following keywords: New Zealand, SCFE, slipped capital femoral epiphysis, SUFE, and slipped upper femoral epiphysis. The references were also screened. RESULTS Eight original scientific research articles that had been published in peer-reviewed journals were identified, as well as 4 published abstracts from conference proceedings; we summarized the key findings. The New Zealand Māori and Pacific ethnicities have the highest reported burden of SCFE, with 4.2 and 5.6 times the prevalence, respectively, when compared with New Zealand European (Caucasian). Māori children are younger at presentation (p = 0.002) and more frequently present with bilateral SCFE (p = 0.05), and there is a strong link with childhood obesity. A contralateral posterior sloping angle (PSA) of ≥14° may be used as an adjunct threshold for decision-making regarding prophylactic pinning. A PSA of ≥40° was found to correlate with a higher likelihood of unsatisfactory functional outcome following SCFE pinning in situ. When conversion to total hip arthroplasty is eventually required due to SCFE, early functional outcomes are similar to those of patients with primary osteoarthritis, and revision rates and mortality rates are not significantly different. CONCLUSIONS Landmark literature from New Zealand has been published on SCFE management, and there is a promising future of quality, impactful research. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Pierre Navarre
- Southland Hospital, Invercargill, New Zealand.,University of Otago, Dunedin, New Zealand
| |
Collapse
|
|
47
|
Zuo B, Zhu JF, Wang XY, Wang CL, Ma F, Chen XD. Outcome of the modified Dunn procedure in severe slipped capital femoral epiphysis. J Orthop Surg Res 2020; 15:506. [PMID: 33143737 PMCID: PMC7641796 DOI: 10.1186/s13018-020-02036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background The modified Dunn procedure has rapidly gained popularity as a treatment for slipped capital femoral epiphysis (SCFE) during the past few years. However, there is limited information regarding its safety and efficacy in severe slips with this procedure. The purpose of this study is to present clinical results and incidence of complications associated with the modified Dunn osteotomy in a consecutive series of severe SCFE cohort. Patients and methods We retrospectively assessed the outcomes of all twenty patients who had been treated with the modified Dunn procedure in our tertiary-care institution. According to the Loder and Fahey criteria, all cases were classified as severe slips; nineteen cases were stable, and one case was an unstable slip. All surgical procedures were performed by one senior orthopedic surgeon who had specific training in the modified Dunn procedure. Operative reports, outpatient records, follow-up radiographs, and the intraoperative findings were reviewed to determine the demographic information, type of fixation, final slip angle, presence of avascular necrosis (AVN), and any additional complications. The mean age of the patients was 13.2 ± 1.6 years (range, 10 to 17 years). Twenty patients (twenty-one hips) with a mean of 31.2 ± 14 months (range, 12 to 57 months) follow-up met the inclusion criteria. Pain and function were assessed by the modified Harris score and WOMAC score. Radiographic anatomy was measured using the slip angle and α-angle. The radiographic findings related to the anatomy of the femoral head-neck junction, as well as signs of early-onset of osteoarthritis (OA) and AVN, were evaluated pre- and postoperatively. Results Overall, nineteen patients had excellent clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient (5%) who developed implant failure at 3 months postoperatively had a poor outcome. The mean preoperative slip angle was corrected from 63.2 ± 8.1° (range, 51 to 84°) to a normal value of 7.5 ± 3.5° (range, 2 to 15°) (p < 0.01). The mean α-angle was improved from an average of 94.5 ± 21.1° (range, 61 to 123°) to postoperative 42 ± 6.4° (range, 25 to 55°) (p < 0.01). The mean modified Harris hip and WOMAC scores postoperatively were 96.7 ± 13.4 (range, 40 to 100) and 95.4 ± 10.6 (range, 38 to 100), respectively. There were no cases of the development of femoroacetabular impingement (FAI) and the progression of OA. We did not record any case of AVN, closure of the growth plate, heterotopic ossification (HO), trochanteric nonunion, or limb length discrepancy that occurred postoperatively either at the most recent follow-up. Conclusions Our series of severe SCFEs treated with the modified Dunn osteotomy demonstrated that the procedure is safe and capable of restoring more normal proximal femoral anatomy by maximum correction of the slip angle, minimizing probability of secondary FAI and early onset of OA. However, despite its lower surgical complication rate compared with alternative treatment described in the literature for SCFE, AVN can and do occur postoperatively which should always be concerned in every hip.
Collapse
Affiliation(s)
- Bin Zuo
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China.
| | - Jun Feng Zhu
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China.
| | - Xu Yi Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Cheng Long Wang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China
| | - Fei Ma
- Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China.
| | - Xiao Dong Chen
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China.
| |
Collapse
|
|
48
|
Gautier E, Passaplan C, Gautier L. Epiphyseal Angulation and Related Spatial Orientation in Slipped Capital Femoral Epiphysis: Theoretical Model and Biomechanical Explanation of Varus and Valgus Slip. JB JS Open Access 2020; 5:e20.00099. [PMID: 33376931 PMCID: PMC7757839 DOI: 10.2106/jbjs.oa.20.00099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The management of slipped capital femoral epiphysis (SCFE) is controversial. Surgical decision-making is based regularly on the chronicity, stability, and severity of the slip. The purpose of this study was to determine the true angulation and spatial orientation of the epiphysis in hips with SCFE and contralateral hips. METHODS Eighteen hips in 18 patients with SCFE were included in the analysis. Trigonometric calculations, based on angle measurements using 2 conventional radiographs in planes that are perpendicular to each other, were used to determine the angulation of the epiphysis and its orientation in space. RESULTS The mean absolute epiphyseal obliquity of the SCFE hips was 56.2° and the spatial orientation was 36.5°. The mean obliquity of the contralateral side was 34.0°, with a related spatial orientation of 16.8°. The maximum error can reach up to 9.9° (or 41%) when comparing the calculated angles with the angle measurements on radiographs. CONCLUSIONS On standard radiographs, the epiphyseal angulation in SCFE is consistently underestimated. As a consequence, the assigned classification of some patients may be 1 severity group too low, which impacts the value of traditional severity classification for surgical decision-making. The analysis of the spatial orientation of the slip with the concomitant direction of the resultant shear can partially explain varus and valgus slip in SCFE. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Emanuel Gautier
- Department of Orthopaedic Surgery, HFR–Cantonal Hospital, Fribourg, Switzerland
| | - Caroline Passaplan
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | | |
Collapse
|
|
49
|
The diagnosis and management of common childhood orthopedic disorders: An update. Curr Probl Pediatr Adolesc Health Care 2020; 50:100884. [PMID: 33069588 DOI: 10.1016/j.cppeds.2020.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Musculoskeletal illness represents a significant portion of office visits to primary and urgent care clinicians. Despite this, little emphasis is placed on learning pediatric orthopaedics during medical school or residency. The focus of this paper is to provide a systematic approach to this general musculoskeletal physical exam and to assist in the recognition of what conditions are normal development and what conditions require observation, workup and referral to an experienced pediatric orthopaedist.
Collapse
|
|
50
|
Lee J, Lillia JA, Bellemore JM, Little DG, Cheng TL. The Universal Entry Point with oblique screw is superior to fixation perpendicular to the physis in moderate slipped capital femoral epiphysis. J Child Orthop 2020; 14:358-363. [PMID: 33204342 PMCID: PMC7666795 DOI: 10.1302/1863-2548.14.190178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Stable slipped capital femoral epiphysis (SCFE) is often treated with in situ pinning, with the current gold standard being stabilization with a screw perpendicular to the physis. However, this can lead to impingement and a potentially unstable construct. In this study we model the biomechanical effect of two screw positions used for SCFE fixation. We hypothesize that single screw fixation into the centre of the femoral head from the anterior intertrochanteric line (the Universal Entry Point or UEP) provides a more stable construct than single screw fixation perpendicular to the physis with an anterior starting point. METHODS Sawbone models of moderate SCFE were used to mechanically test the two screw constructs and an unfixed control group. Models were loaded to failure with a shear load applied through the physis in an Instron mechanical tester. The primary outcomes were maximum load, stiffness and energy to failure. RESULTS Screw fixation into the centre of the femoral head from the UEP resulted in a greater load to failure (+19%), stiffness (+13%) and energy to failure (+45%) than screw fixation perpendicular to the physis. CONCLUSIONS In this sawbone construct, screw fixation into the centre of the femoral head from the UEP provides greater biomechanical stability than screw fixation perpendicular to the physis. This approach may also benefit by avoiding an intracapsular entry point in soft metaphyseal bone and subsequent risk of impingement and loss of position.
Collapse
Affiliation(s)
- Jillian Lee
- Department of Orthopaedic Surgery, the Children’s Hospital at Westmead, Sydney, NSW, Australia,EPIC Lab, the Children’s Hospital at Westmead, Sydney, NSW, Australia
| | | | - Jeremy M. Bellemore
- Department of Orthopaedic Surgery, the Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - David G. Little
- Department of Orthopaedic Surgery, the Children’s Hospital at Westmead, Sydney, NSW, Australia,EPIC Lab, the Children’s Hospital at Westmead, Sydney, NSW, Australia,Department of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tegan L. Cheng
- EPIC Lab, the Children’s Hospital at Westmead, Sydney, NSW, Australia,Department of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia,Correspondence should be sent to Tegan Cheng, EPIC Lab, Kids Research, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. E-mail:
| |
Collapse
|