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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: 0] [Impact Index Per Article: 0] [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.
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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.
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Outcomes in Pediatric Hip FAI Surgery: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:362-368. [PMID: 35917094 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.
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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
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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.
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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
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Longo UG, Papalia R, De Salvatore S, Ruzzini L, Candela V, Piergentili I, Oggiano L, Costici PF, Denaro V. Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015. BMC Musculoskelet Disord 2021; 22:570. [PMID: 34158027 PMCID: PMC8218445 DOI: 10.1186/s12891-021-04435-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10-14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. METHODS Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. RESULTS From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). CONCLUSION National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Leonardo Oggiano
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Saito M, Kuroda Y, Sunil Kumar KH, Khanduja V. Outcomes After Arthroscopic Osteochondroplasty for Femoroacetabular Impingement Secondary to Slipped Capital Femoral Epiphysis: A Systematic Review. Arthroscopy 2021; 37:1973-1982. [PMID: 33359821 DOI: 10.1016/j.arthro.2020.12.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the efficacy of arthroscopic osteochondroplasty for patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). METHODS A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 1, 2019. Data including patient demographics, slip severity according to Southwick, outcomes, and complications were retrieved from eligible studies that reported a minimum 3-month follow-up of arthroscopic osteochondroplasty for FAI secondary to SCFE. Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess quality of studies. Heterogeneity and quality were evaluated using P values and the I2 statistic. RESULTS Six studies (90 hips) were analyzed. The range of MINORS scores was 8 to 11. Most studies were level of evidence 4 (n = 4, 66.7%), with more men than women (n = 5, 83.3%). The ranges of age, body mass index, and follow-up length after surgery were 10 to 42 years, 17.5 to 32.3 kg/m2, and 3 to 56 months, respectively. The Modified Harris Hip Score (mHHS) was the most commonly used score to report on clinical outcomes (n = 2 studies, 28 hips) with a significant improvement following surgery. Three studies reported an improvement in internal rotation (IR) of the hip with a range of improvement of 17° to 32°, with low heterogeneity (I2 = 0% and P = .531). Five studies reported a significant correction of the α angle, with range of improvement of 19.9° to 37.3°. The range of postoperative α angle was 32° to 67°, and 3 studies achieved appropriate postoperative α angle (40° to 50°), with low heterogeneity (I2 = 8.4% and P = .336). The total number of complications was 8 (1 major complication) and there were 6 revisions, with low heterogeneity. CONCLUSION Arthroscopic osteochondroplasty for FAI secondary to SCFE provides good short- to medium-term outcomes and improves IR of the hip, with the ability to potentially correct the α angle with a low rate of complications and revision. LEVEL OF EVIDENCE IV, systematic review of level II to IV studies.
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Affiliation(s)
- Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Karadi Hari Sunil Kumar
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
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Hodgson F, Ibáñez A. DOLOR DE CADERA EN ADOLESCENTES: ESTUDIO Y TRATAMIENTO. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Salas AP, Brizuela-Ventura M, Velasco-Vazquez H, Mazek J. The Outside-In Technique for Slipped Capital Femoral Epiphysis: A Safe and Reproducible Approach in Hip Arthroscopy. Arthrosc Tech 2020; 9:e493-e497. [PMID: 32368469 PMCID: PMC7189202 DOI: 10.1016/j.eats.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement syndrome caused by slipped capital femoral epiphysis (SCFE) can be successfully treated arthroscopically and with the minimally invasive, outside-in surgical technique. The advantages of the technique are that the residual cam-type deformity caused by the slippage can be corrected and reconstructed reliably and reproducibly before distracting the hip joint; and radiation with fluoroscopy is used for only definitive reduction and reconstruction, which is obtained with cannulated screws. In addition, this safe technique allows distraction of the hip after screw placement, without affecting the reconstruction, to address labral tears and chondrolabral delaminations caused by the impingement.
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Affiliation(s)
- Antonio Porthos Salas
- Hip Arthroscopy and Preservation Mexico, San Pedro Garza Garcia, Mexico
- Address correspondence to Antonio Porthos Salas, M.D., Hip Arthroscopy and Preservation Mexico, Hospital Angeles Valle Oriente, Montes Rocallosos 209, 66290 San Pedro Garza Garcia, Mexico.
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