Outcomes of Arthroscopically Treated Femoroacetabular Impingement in Children and Adolescents With Slipped Capital Femoral Epiphysis and Legg-Calve-Perthes Disease

Abstract

Legg-Calve-Perthes disease (Perthes) and slipped capital femoral epiphysis (SCFE) are childhood hip diseases that have lifelong effects. They are severe deformities that lead to femoroacetabular impingement and ultimately earlier symptomatic osteoarthritis of the hip. Traditional open procedures to treat FAI secondarily to Perthes and SCFE cause significant morbidity and have significant recovery time. Arthroscopic hip osteoplasty has been described to treat these patients in a minimally-invasive manner. The purpose of this paper is to report outcomes of arthroscopically treated FAI in SCFE and Perthes patients 18 years of age and younger. Each patient that underwent hip arthroscopy by the senior author (MS) completed the Modified Harris Hip Score, VAS numeric pain scale, and the SF 12 questionnaire at standard intervals as part of an ongoing quality improvement project. They are also asked to quantify their improvement compared to pre operatively in a percentage form. The data was collected prospectively and maintained in a password-protected spreadsheet. With Institutional Review Board (IRB) approval, we performed a retrospective review of the collected data and medical records focusing on children or adolescents who were 18 years of age or younger with diagnosed SCFE or Perthes disease. We had 8 patients that conformed to the criteria: 3 previous SCFE patients and 5 patients with Perthes disease. All patients underwent femoral neck osteoplasty with 1 SCFE patient and 3 Perthes patients having their labrum repaired. Six of the 8 patients had at least 1 year follow up. With the exception of one Perthes patient, all patients improved per the administered questionnaires. The one Perthes patient that did not improve had drastically worsening hip pain with worsening of each score on the questionnaires. To our knowledge, there have not been any published results for post-SCFE arthroscopic osteoplasty in adolescents. There have been reports of the management and successful outcomes of hip arthroscopy in Perthes disease, however these studies include all ages treated and do not focus specifically on the adolescent population. In this study, we focus specifically on pediatric patients with SCFE and Perthes treated in a pediatric hospital setting by a sports medicine fellowship-trained orthopaedic surgeon. Our study demonstrates that FAI in SCFE and Perthes adolescents can be treated successfully with arthroscopic osteoplasties. Arthroscopic treatment can be used with reliable results to relieve symptoms from previous hip deformities providing a less invasive option than the traditional open procedures to these patients.