Abstract
PurposeThe purpose of this retrospective study was to evaluate the long-term outcome of different methods of treatment in slipped capital femoral epiphysis (SCFE), to find risk factors for poor outcome, and to assess whether prophylactic fixation is indicated.MethodsSixty-six patients (76 hips) treated for SCFE with a mean follow-up of 38 years (range 21–57 years) were evaluated. All except seven patients had chronic SCFE. Ten patients (15%) had bilateral affection. Three methods of treatment had been used: screw fixation (35 hips), bone-peg epiphysiodesis (30 hips), and bone-peg epiphysiodesis combined with corrective femoral osteotomy (11 hips). The long-term clinical outcome was classified as good when the patient had not undergone total hip replacement (THR), when the Harris hip score (HHS) was 85 points or above, or the patient had no pain. Good radiographic outcome was defined as no THR or osteoarthritis (OA).ResultsIn 51 patients with chronic slip (mean slip angle 32°) treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg epiphysiodesis. Eight patients with large chronic slip (mean slip angle 53°) were treated with bone-peg epiphysiodesis and corrective femoral osteotomy, and the clinical outcome was poor in six patients. Seven patients with acute slip had larger mean slip angle (57°) and more complications than those with chronic slip, and the long-term outcome was poor in all. Two hips out of 42 (5%) had OA in the contralateral hip at follow-up.ConclusionIn situ fixation of chronic SCFE gave satisfactory long-term outcome irrespective of the treatment method. Corrective femoral osteotomy did not improve the outcome in hips with large slip angles. Acute SCFE had poor outcome. Prophylactic fixation of the contralateral hip is barely necessary.
Highlights
Slipped capital femoral epiphysis (SCFE) is the most frequent hip disorder among adolescents
Three methods of treatment had been used: screw fixation (35 hips), bone-peg epiphysiodesis (30 hips), and bone-peg epiphysiodesis combined with corrective femoral osteotomy (11 hips)
In 51 patients with chronic slip treated with in situ fixation, the clinical outcome was good in 35 patients (69%) and there was no significant difference between screw fixation and bone-peg epiphysiodesis
Summary
Slipped capital femoral epiphysis (SCFE) is the most frequent hip disorder among adolescents. There is a risk of developing osteoarthritis (OA) later in life, but symptomatic OA generally does not appear until the fourth or fifth decade of life [1,2,3,4]. Long-term follow-up studies are necessary to predict outcome. The aim of treatment in SCFE is to prevent further slip and avoid complications like chondrolysis and avascular necrosis. Percutaneous in situ fixation with a single cannulated screw has shown consistently good results [5,6,7] and is presently widely used. Before the era of screw and pin fixation, open bone-peg epiphysiodesis was used in Norway. In cases with more severe displacement, it was combined with corrective osteotomy of the proximal
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