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Clinical Orthopaedics and Related Research®

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01-07-2013 | Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Authors: Kai Ziebarth, MD, Michael Leunig, MD, Theddy Slongo, MD, Young-Jo Kim, MD, PhD, Reinhold Ganz, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2013

Abstract

Background

Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation.

Questions/purposes

We (1) determined the influence of chronicity of prodromal symptoms and severity of SCFE deformity on severity of cartilage damage. (2) In surgically confirmed disconnected epiphyses, we determined the influence of injury and time to surgery on epiphyseal perfusion; and (3) the frequency of new bone at the posterior neck potentially reducing perfusion during epimetaphyseal reduction.

Methods

We reviewed 116 patients with 119 SCFE and available records treated between 1996 and 2011. Acetabular cartilage damage was graded as +/++/+++ in 109 of the 119 hips. Epiphyseal perfusion was determined with laser-Doppler flowmetry at capsulotomy and after reduction. Information about bone at the posterior neck was retrieved from operative reports.

Results

Ninety-seven of 109 hips (89%) had documented cartilage damage; severity was not associated with higher slip angle or chronicity; disconnected epiphyses had less damage. Temporary or definitive cessation of perfusion in disconnected epiphyses increased with time to surgery; posterior bone resection improved the perfusion. In one necrosis, the retinaculum was ruptured; two were in the group with the longest time interval. Posterior bone formation is frequent in disconnected epiphyses, even without prodromal periods.

Conclusions

Addressing the cause of cartilage damage (cam impingement) should become an integral part of SCFE surgery. Early surgery for disconnected epiphyses appears to reduce the risk of necrosis. Slip reduction without resection of posterior bone apposition may jeopardize epiphyseal perfusion.

Level of Evidence

Level IV, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery
Authors: Kai Ziebarth, MD
Michael Leunig, MD
Theddy Slongo, MD
Young-Jo Kim, MD, PhD
Reinhold Ganz, MD
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2818-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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