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A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

  • Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE.

Questions/purposes

We therefore determined whether (1) BMI percentile was a risk factor for BL-SCFE; and (2) postoperative increases and/or decreases in BMI percentile influenced the risk for BL-SCFE.

Methods

We retrospectively reviewed the records of 502 patients surgically treated for SCFE and identified 138 (27%) with BL-SCFE and 364 (73%) with unilateral SCFE (UL-SCFE); 173 patients, 60 (35%) with BL-SCFE and 113 (65%) with UL-SCFE met our inclusion criteria. Risk factors included sex, age, slip stability, slip chronicity, slip angle, and obesity. Percentile BMI was recorded at the time of first SCFE surgery, at the time of last followup for patients undergoing UL-SCFE, and at the time of second SCFE surgery for patients undergoing BL-SCFE.

Results

Sex, age, slip stability, and slip angle were not associated with BL-SCFE. Postoperative obesity (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2–9.7) and acute slip chronicity (OR, 2.9; 95% CI, 1.3–6.7) had higher risks for sequential BL-SCFE. Obese patients who became nonobese postoperatively had a decreased risk of sequential BL-SCFE compared with those who remained obese (OR, 0.16; 95% CI, 1.2–116.5).

Conclusions

Only postoperative obesity and an acute slip were risk factors for sequential BL-SCFE. BMI reduction to lower than the 95% percentile after SCFE surgery was associated with lower risk for BL-SCFE development. The data suggest early supervised therapeutic weight management programs for patients treated for UL-SCFE are important to reduce risk of subsequent SCFE.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA

    Adam Y. Nasreddine MA, Benton E. Heyworth MD, David Zurakowski PhD & Mininder S. Kocher MD, MPH

  2. Division of Sports Medicine, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA

    David Zurakowski PhD & Mininder S. Kocher MD, MPH

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  1. Adam Y. Nasreddine MA
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  2. Benton E. Heyworth MD
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  3. David Zurakowski PhD
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  4. Mininder S. Kocher MD, MPH
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Correspondence to Mininder S. Kocher MD, MPH.

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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.

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Nasreddine, A.Y., Heyworth, B.E., Zurakowski, D. et al. A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis. Clin Orthop Relat Res 471, 2137–2144 (2013). https://doi.org/10.1007/s11999-013-2811-3

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