Top

Clinical Orthopaedics and Related Research®

Published in:

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

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Authors: Yaser M. K. Baghdadi, MD, A. Noelle Larson, MD, Rafael J. Sierra, MD, Hamlet A. Peterson, MD, Anthony A. Stans, MD

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

Abstract

Background

The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear.

Questions/purposes

We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning.

Methods

We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2–43 years).

Results

Of the 133 patients at risk for a subsequent slip, 20 patients developed a contralateral slip (15%). One patient developed avascular necrosis requiring arthroplasty, and another patient had a mild contralateral slip with disabling pain. For the 15 patients with contralateral slips and scores available, the mean HHS was 90 (range, 49–100) and the mean VAS pain score was 20 of 100. Six found the contralateral hip painful.

Conclusions

The contralateral slip sustained by the majority of patients was for the most part mild. However, nearly 1/3 of the contralateral slipped hips were painful. One patient has severe pain, and a second required THA for avascular necrosis after an unstable slip. These may have been preventable by prophylactic pinning.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.PubMed

Aronsson DD, Loder RT. Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:99–110.PubMedCrossRef

Barrios C, Blasco MA, Blasco MC, Gasco J. Posterior sloping angle of the capital femoral physis: a predictor of bilaterality in slipped capital femoral epiphysis. J Pediatr Orthop. 2005;25:445–449.PubMedCrossRef

Billing L, Severin E. Slipping epiphysis of the hip; a roentgenological and clinical study based on a new roentgen technique. Acta Radiol Suppl. 1959;174:1–76.PubMed

Castaneda P, Macias C, Rocha A, Harfush A, Cassis N. Functional outcome of stable grade III slipped capital femoral epiphysis treated with in situ pinning. J Pediatr Orthop. 2009;29:454–458.PubMedCrossRef

Castro FP Jr, Bennett JT, Doulens K. Epidemiological perspective on prophylactic pinning in patients with unilateral slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20:745–748.PubMedCrossRef

Dodds MK, McCormack D, Mulhall KJ. Femoroacetabular impingement after slipped capital femoral epiphysis: does slip severity predict clinical symptoms? J Pediatr Orthop. 2009;29:535–539.PubMedCrossRef

Fraitzl CR, Kafer W, Nelitz M, Reichel H. Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br. 2007;89:1592–1596.PubMed

Hagglund G. The contralateral hip in slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:158–161.PubMedCrossRef

10.

Hagglund G, Hansson LI, Ordeberg G. Epidemiology of slipped capital femoral epiphysis in southern Sweden. Clin Orthop Relat Res. 1984;191:82–94.PubMed

11.

Hagglund G, Hansson LI, Ordeberg G, Sandstrom S. Bilaterality in slipped upper femoral epiphysis. J Bone Joint Surg Br. 1988;70:179–181.PubMed

12.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

13.

Hurley JM, Betz RR, Loder RT, Davidson RS, Alburger PD, Steel HH. Slipped capital femoral epiphysis: the prevalence of late contralateral slip. J Bone Joint Surg Am. 1996;78:226–230.PubMed

14.

Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–414.PubMedCrossRef

15.

Klein A, Joplin RJ, Reidy JA, Hanelin J. Management of the contralateral hip in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1953;35:81–87.PubMed

16.

Kocher MS, Bishop JA, Hresko MT, Millis MB, Kim YJ, Kasser JR. Prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis. J Bone Joint Surg Am. 2004;86:2658–2665.PubMed

17.

Koenig KM, Thomson JD, Anderson KL, Carney BT. Does skeletal maturity predict sequential contralateral involvement after fixation of slipped capital femoral epiphysis? J Pediatr Orthop. 2007;27:796–800.PubMedCrossRef

18.

Larson AN, McIntosh AL, Trousdale RT, Lewallen DG. Avascular necrosis most common indication for hip arthroplasty in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:767–773.PubMedCrossRef

19.

Larson AN, Sierra RJ, Yu EM, Trousdale RT, Stans AA. Outcomes of slipped capital femoral epiphysis treated with in situ pinning. J Pediatr Orthop. 2012;32:125–130.PubMedCrossRef

20.

Larson AN, Yu EM, Melton LJ 3rd, Peterson HA, Stans AA. Incidence of slipped capital femoral epiphysis: a population-based study. J Pediatr Orthop B. 2010;19:9–12.PubMedCrossRef

21.

Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–375.PubMedCrossRef

22.

Loder RT. The demographics of slipped capital femoral epiphysis: an international multicenter study. Clin Orthop Relat Res. 1996;322:8–27.PubMed

23.

Loder RT. Controversies in slipped capital femoral epiphysis. Orthop Clin North Am. 2006;37:211–221, vii.

24.

Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis: a study of children in Michigan. J Bone Joint Surg Am. 1993;75:1141–1147.PubMed

25.

Loder RT, Starnes T, Dikos G. Atypical and typical (idiopathic) slipped capital femoral epiphysis: reconfirmation of the age-weight test and description of the height and age-height tests. J Bone Joint Surg Am. 2006;88:1574–1581.PubMedCrossRef

26.

Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop. 1995;15:349–356.PubMedCrossRef

27.

Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001;29:213–218.PubMed

28.

Miese FR, Zilkens C, Holstein A, Bittersohl B, Kropil P, Mamisch TC, Lanzman RS, Bilk P, Blondin D, Jager M, Krauspe R, Furst G. Assessment of early cartilage degeneration after slipped capital femoral epiphysis using T2 and T2* mapping. Acta Radiol. 2011;52:106–110.PubMed

29.

Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.PubMedCrossRef

30.

Ordeberg G, Hansson LI, Sandstrom S. Slipped capital femoral epiphysis in southern Sweden: long-term result with no treatment or symptomatic primary treatment. Clin Orthop Relat Res. 1984;191:95–104.PubMed

31.

Popejoy D, Emara K, Birch J. Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score. J Pediatr Orthop. 2012;32:290–294.PubMedCrossRef

32.

Resnick D. The “tilt deformity” of the femoral head in osteoarthritis of the hip: a poor indicator of previous epiphysiolysis. Clin Radiol. 1976;27:355–363.PubMedCrossRef

33.

Riad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. 2007;27:411–414.PubMedCrossRef

34.

Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1:43–46.PubMedCrossRef

35.

Sankar WN, Brighton BK, Kim YJ, Millis MB. Acetabular morphology in slipped capital femoral epiphysis. J Pediatr Orthop. 2011;31:254–258.PubMedCrossRef

36.

Seller K, Raab P, Wild A, Krauspe R. Risk-benefit analysis of prophylactic pinning in slipped capital femoral epiphysis. J Pediatr Orthop B. 2001;10:192–196.PubMed

37.

Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92:2898–2908.PubMedCrossRef

38.

Stulberg SD CL, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The Hip: Proceedings of the Third Open Scientific Meeting of the Hip Society. St Louis, MO: CV Mosby: 1975:212–228.

39.

Thillemann TM, Pedersen AB, Johnsen SP, Soballe K. Implant survival after primary total hip arthroplasty due to childhood hip disorders: results from the Danish Hip Arthroplasty Registry. Acta Orthop. 2008;79:769–776.PubMedCrossRef

40.

Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.PubMedCrossRef

41.

Woelfle JV, Fraitzl CR, Reichel H, Nelitz M. The asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis: morbidity of prophylactic fixation. J Pediatr Orthop B. 2012;21:226–229.PubMedCrossRef

42.

Yildirim Y, Bautista S, Davidson RS. Chondrolysis, osteonecrosis, and slip severity in patients with subsequent contralateral slipped capital femoral epiphysis. J Bone Joint Surg Am. 2008;90:485–492.PubMedCrossRef

43.

Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467:704–716.PubMedCrossRef

Title: The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis
Authors: Yaser M. K. Baghdadi, MD
A. Noelle Larson, MD
Rafael J. Sierra, MD
Hamlet A. Peterson, MD
Anthony A. Stans, 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/s11999-012-2762-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

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

Please log in to get access to this content

Other articles of this Issue 7/2013

Isoniazid Could Be Used for Antibiotic-loaded Bone Cement for Musculoskeletal Tuberculosis: An In Vitro Study

Erratum to: What is the Long-term Survival of Impaction Allografting of the Femur?

Letter to the Editor: Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures

The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy

CORR Insights®: Role of Interleukin-6 as an Early Marker of Fat Embolism Syndrome: A Clinical Study

Surgical Technique: Results of Stabilization of Sternoclavicular Joint Luxations Using a Polydioxanone Envelope Plasty