Severe irreducible slipping of upper femoral epiphysis: a review of 14 cases treated by subtrochanteric osteotomy

Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review

Objectives

The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).

Methods

The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies.

Results

Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively.

Conclusion

In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety.

Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1.

Chronic slipped capital femoral epiphysis: a radiographic evaluation of the Southwick osteotomy

The aim of this study was to evaluate the radiographic correction and the complications in Southwick osteotomy for slipped capital femoral epiphysis (SCFE) on the basis of radiographic evaluation. We retrospectively analyzed the charts of 37 patients with chronic, unilateral, moderate, or severe SCFE, who underwent the procedure, verifying Southwick angles, articulotrochanteric distance, and the articular narrowing on preoperative, postoperative periods, and in the last follow-up evaluation, using the contralateral, healthy hip, for comparison. Southwick's angle changed from 117.8 to 147.3° on average (front) and from 56.9 to 19.1° (Lauenstein view). Articulotrochanteric distance changed from 11.3 to 24.1 mm (normal distance 22.1 mm). Joint space changed from 4.3 mm preoperatively to 3.84 mm. Chondrolysis was diagnosed in five cases before and eight cases after surgery. There was no case of avascular necrosis. Southwick osteotomy effectively corrected SCFE deformity. There was a tendency toward excessive valgism.

Extracapsular base of neck osteotomy versus Southwick osteotomy in treatment of moderate to severe chronic slipped capital femoral epiphysis

The aim of this study was to evaluate the results of extracapsular base of neck osteotomy and Southwick osteotomy from clinical and radiologic points of view. This retrospective study included 35 hips in 33 patients who presented with moderate to severe slipped capital femoral epiphysis (SCFE) between 1995 and 2001. These patients were divided into two groups according to the type of osteotomy: group A patients (n = 15) were treated by extracapsular base of neck osteotomy and group B patients (n = 18) were treated by modified Southwick osteotomy. Follow-up averaged 3.5 years (range 1-6 years). Clinical and radiologic evaluations were done before and after surgery. All patients were finally evaluated according to the modified Southwick criteria. Group A had 86.7% satisfactory results; group B had 90% satisfactory results. There was no statistically significant difference between the type of osteotomy and the final outcome. The authors believe that both types of osteotomy are equally safe and effective procedures, with minimal risks of avascular necrosis and chondrolysis, in the treatment of moderate to severe chronic SCFE.