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Schlenzka T, Serlo J, Viljakka T, Tallroth K, Helenius I. In situ fixation of slipped capital femoral epiphysis carries a greater than 40% risk of later total hip arthroplasty during a long-term follow-up. Bone Joint J 2023; 105-B:1321-1326. [PMID: 38035599 DOI: 10.1302/0301-620x.105b12.bjj-2023-0148.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years. Methods In this study, 138 patients with 172 affected hips treated with in situ fixation were evaluated retrospectively. A total of 97 patients (70%) were male and the mean age was 13.6 years (SD 2.1); 35 patients (25%) had a bilateral disease. The median follow-up time was 49 years (interquartile range 43 to 55). Basic demographic, stability, and surgical details were obtained from patient records. Preoperative radiographs (slip angle; SA) were measured, and data on THA was gathered from the Finnish National Arthroplasty Register. Results The preoperative SA was a mean of 39° (SD 19°). At follow-up, 56 of the patients had undergone THA for a hip previously fixed in situ for SCFE (41%) and 64 of all affected hips had been replaced (37%). Kaplan-Meier analysis gave a median prosthesis-free postoperative survival of 55 years (95% confidence interval (CI) 45 to 64) for the affected hips. In a multivariate analysis, female patients had a two-fold risk for THA (hazard ratio (HR) 2.42 (95% CI 1.16 to 5.07)) and a greater preoperative SA increased the risk of THA (HR 1.03 for every increment of 1° (95% CI 1.01 to 1.05)), while patient age at surgery, slip laterality, stability of slip, or diagnostic delay did not have a statistically significant effect on the risk of THA. Conclusion SCFE treated primarily with in situ fixation may lead to THA in more than 40% of affected hips at a near 50-year follow-up. This risk is approximately 15-times the reported lifetime risk in the Finnish general population. Female sex and increasing preoperative SA significantly predicted higher risk of THA.
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Affiliation(s)
- Thomas Schlenzka
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joni Serlo
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Longo UG, Papalia R, De Salvatore S, Ruzzini L, Candela V, Piergentili I, Oggiano L, Costici PF, Denaro V. Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015. BMC Musculoskelet Disord 2021; 22:570. [PMID: 34158027 PMCID: PMC8218445 DOI: 10.1186/s12891-021-04435-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10-14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. METHODS Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. RESULTS From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). CONCLUSION National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Leonardo Oggiano
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Edouard C, Raphaël V, Hubert DLP. Is the femoral head dead or alive before surgery of slipped capital femoral epiphysis? Interest of perfusion Magnetic Resonance Imaging. J Clin Orthop Trauma 2014; 5:18-26. [PMID: 25983464 PMCID: PMC4009453 DOI: 10.1016/j.jcot.2014.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/24/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The most common complication of slipped capital femoral epiphysis (SCFE) is avascular necrosis (AVN) of the femoral head. Surgical treatments including reduction of the femoral head are considered as a risk factor for avascular necrosis. The purpose of this study was to investigate the role of perfusion Magnetic Resonance Imaging (MRI) into the surgical decision-making sequence. METHODS Eighteen children with 19 slipped capital femoral epiphysis were retrospectively included. SFCE was unstable in nine cases and stable in ten cases. The slip angle was higher than 60° in 14 cases. Perfusion MRI with dynamic gadolinium-enhanced subtraction sequences were done in all the cases before and after surgical treatment. RESULTS On nineteen hips, eight were devascularized before surgery. All were unstable. After surgery, six on eight had a complete revascularization, one had a focal necrosis and one remained devascularized. A postoperative devascularization with normal preoperative MRI was noted once. On nineteen hips, a total of three avascular necrosis occurred. CONCLUSION Perfusion MRI is useful to assess preoperative and postoperative vascular status in SFCE. Preoperative devascularization could improve or stay equal after surgical treatment. Persistent devascularization could be responsible for avascular necrosis of the femoral head.
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Affiliation(s)
- Chambenois Edouard
- Université Pierre et Marie Curie Paris6, Department of Pediatric Imaging, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571 Paris Cedex 12, France
| | - Vialle Raphaël
- Université Pierre et Marie Curie Paris6, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571 Paris Cedex 12, France
| | - Ducou Le Pointe Hubert
- Université Pierre et Marie Curie Paris6, Department of Pediatric Imaging, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571 Paris Cedex 12, France,Corresponding author. Tel.: +33 14736124; fax: +33 144736511.
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Mostoufi-Moab S, Isaacoff EJ, Spiegel D, Gruccio D, Ginsberg JP, Hobbie W, Shults J, Leonard MB. Childhood cancer survivors exposed to total body irradiation are at significant risk for slipped capital femoral epiphysis during recombinant growth hormone therapy. Pediatr Blood Cancer 2013; 60:1766-71. [PMID: 23818448 PMCID: PMC4564250 DOI: 10.1002/pbc.24667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/03/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Childhood cancer survivors treated with cranial or total body irradiation (TBI) are at risk for growth hormone deficiency (GHD). Recombinant growth hormone (rhGH) therapy is associated with slipped capital femoral epiphysis (SCFE). We compared the incidence of SCFE after TBI versus cranial irradiation (CI) in childhood cancer survivors treated with rhGH. PROCEDURE Retrospective cohort study (1980-2010) of 119 survivors treated with rhGH for irradiation-induced GHD (56 TBI; 63 CI). SCFE incidence rates were compared in CI and TBI recipients, and compared with national registry SCFE rates in children treated with rhGH for idiopathic GHD. RESULTS Median survivor follow-up since rhGH initiation was 4.8 (range 0.2-18.3) years. SCFE was diagnosed in 10 subjects post-TBI and none after CI (P < 0.001). All 10 subjects had atypical valgus SCFE, and 7 were bilateral at presentation. Within TBI recipients, age at cancer diagnosis, sex, race, underlying malignancy, age at radiation, and age at initiation of rhGH did not differ significantly between those with versus without SCFE. The mean (SD) age at SCFE diagnosis was 12.3 (2.7) years and median duration of rhGH therapy to SCFE was 1.8 years. The SCFE incidence rate after TBI exposure was 35.9 per 1,000 person years, representing a 211-fold greater rate than reported in children treated with rhGH for idiopathic GH deficiency. CONCLUSIONS The markedly greater SCFE incidence rate in childhood cancer survivors with TBI-associated GHD, compared with rates in children with idiopathic GHD, suggests that cancer treatment effects to the proximal femoral physis may contribute to SCFE.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Correspondence to: Sogol Mostoufi-Moab, MD, MSCE, The Children’s Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104.
| | - Elizabeth J. Isaacoff
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David Spiegel
- Division of Orthopedics, Department of Surgery, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Denise Gruccio
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jill P. Ginsberg
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wendy Hobbie
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Justine Shults
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mary B. Leonard
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Thomsen L, Vialle R, Maillet M, Mary P, Damsin JP, Filipe G. The progressive longitudinal traction reduction of unstable slipped capital femoral epiphysis: preliminary results in 11 patients. J Child Orthop 2007; 1:121-5. [PMID: 19308484 PMCID: PMC2656712 DOI: 10.1007/s11832-007-0030-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 05/15/2007] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Unstable slipped capital femoral epiphysis is rare, but is frequently associated with avascular necrosis. The rapid and complete reduction of the epiphysis displacement was shown to be responsible for this complication. We present the preliminary results of a progressive reduction technique of epiphysis displacement. METHODS A total of 11 patients treated using progressive traction and internal fixation were reviewed retrospectively. Only children who underwent clinical and radiological follow-up for at least 18 months were included in this study to detect avascular necrosis. RESULTS The mean posterior displacement of the femoral head was 67 degrees and mean traction duration was 13 days. Of the patients, 2 had cutaneous problems requiring traction interruption, one on day 5 and the other on day 9. The mean residual slip was 16 degrees and 3 patients had complete or partial avascular necrosis well tolerated at the final follow-up. CONCLUSION Our experience showed that if traction is supported for more than 2 weeks, a good correction of the epiphysis displacement can be obtained. Our short series does not allow affirmation of the superiority of our therapeutic strategy, especially with regards to avascular necrosis of the femoral head.
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Affiliation(s)
- Laurent Thomsen
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
| | - Raphaël Vialle
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
| | - Marie Maillet
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
| | - Pierre Mary
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
| | - Jean-Paul Damsin
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
| | - Georges Filipe
- Armand Trousseau Hospital, Department of Paediatric Orthopaedics, Université Pierre et Marie Curie-Paris 6, 26, Avenue du Docteur Arnold Netter, Paris Cedex 12, 75571 France
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