Early Results of Treatment of Hip Impingement Syndrome in Slipped Capital Femoral Epiphysis and Pistol Grip Deformity of the Femoral Head-Neck Junction Using the Surgical Dislocation Technique

Abstract

Pistol grip deformity of the femoral head-neck junction and slipped capital femoral epiphysis can cause anterior impingement leading to pain, cartilage damage and eventual osteoarthritis. Osteoplasty of this metaphyseal prominence, with or without concomitant intertrochanteric osteotomy, using a surgical dislocation approach, can effectively treat this problem. Clinical and radiographic outcomes were assessed in 19 patients who underwent osteoplasty or osteoplasty/intertrochanteric osteotomy via Ganz-type surgical dislocation with average 12-month follow-up. Preoperative and postoperative Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaires and radiographs were obtained and evaluated. In the osteoplasty group, 7 patients improved, 4 were unchanged, and 2 worsened. In the osteoplasty/osteotomy group, 5 of 6 patients improved. Patients with chondral flaps had less improvement. No avascular necrosis was noted postoperatively, and all trochanteric osteotomies healed. The surgical dislocation approach, combined with osteoplasty and/or bony realignment, is a safe efficacious treatment option for symptomatic pistol grip deformity. Outcomes are worse if there is preexisting cartilage damage.