Delayed Reconstruction of Slipped Capital Femoral Epiphysis Deformity

Abstract

Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder. Its cause is not fully understood but is likely multifactorial involving biological, vascular, and biomechanical factors. The current management of SCFE is focused on stabilizing the proximal femoral epiphysis as it translates along the physis. In significant deformities the epiphysis remains in a posterior, inferior, and retroverted position after fixation. Some patients undergo osseous remodeling to resolve the deformity, but most will have residual deformity into adulthood. Residual deformity of the proximal femur frequently leads to a cam-type femoroacetabular impingement, which can expedite the process of degenerative osteoarthritis. Many approaches to surgically address post-SCFE femoroacetabular impingement have been described, including femoral neck osteoplasties to remove the impinging lesion and proximal femoral osteotomies to realign the femoral head within the acetabulum. Below, we describe a combined approach involving surgical hip dislocation with open osteoplasty followed by an intertrochanteric osteotomy. This operation addresses both aspects of the proximal femoral deformity associated with SCFE and is an optimal approach for correcting severe deformities.