, Volume 471, Issue 7, pp 2124-2131
Date: 03 Jan 2013

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

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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.

The institution of the authors has received, during the study period, funding from the Mid-America Orthopaedic Association (Rochester, MN, USA).
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.