Clinical Orthopaedics and Related Research®

, Volume 471, Issue 7, pp 2156–2162

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Authors

  • Kai Ziebarth
    • Department of Orthopaedic SurgeryInselspital
    • University of Berne
    • Department of Orthopedics, Orthopaedic SurgerySchulthess Clinic
  • Theddy Slongo
    • University of Berne
    • Department of Pediatric OrthopaedicsInselspital
  • Young-Jo Kim
    • Department of Orthopaedic SurgeryBoston Children’s Hospital
  • Reinhold Ganz
    • University of Berne
Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts

DOI: 10.1007/s11999-013-2818-9

Cite this article as:
Ziebarth, K., Leunig, M., Slongo, T. et al. Clin Orthop Relat Res (2013) 471: 2156. doi:10.1007/s11999-013-2818-9

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.

Copyright information

© The Association of Bone and Joint Surgeons® 2013