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Anatomical Reconstruction of the Hip with SCFE, Justified by Pathophysiological Findings

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European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 13))

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Abstract

In the past, arthrotomy of the hip was rarely executed when SCFE was treated operatively and pathophysiological reflexions were mainly based on radiological and clinical observations. With surgical subluxation or dislocation as part of the treatment concept, new information was possible and more precise management plans could be established. Based on more than 100 SCFE-hips nearly 90 % had acetabular cartilage damage due to cam impingement; hips with disconnected epiphyses at surgery had significantly less damage. In slips with epiphyseal disconnection the incidence of disturbed perfusion increased with time to surgery. On the other hand, perfusion improved with epiphyseal reduction when performed after resection of posterior bone apposition. We speculate that one of three necroses could be related to the injury of disconnection with ruptured retinaculum, while the two others were observed in hips with a long time interval before surgery. Posterior bone apposition can be present in acute slips without prodromes.

In conclusion, even minor slips produce acetabular cartilage damage and therefore the cam deformity should be treated as well. In slips with disconnected epiphysis the injury seems not to be the major cause of necrosis; time to surgery plays a role by increasing the risk of capsular tamponade and kinking or stretching of the retinacular vessels with epiphyseal mobility and displacement. Resection of bone apposition at the posterior neck in stable and disconnected epiphyses protects the perfusion of the epiphysis during anatomical reduction.

Erwin Morscher Honorary Lecture. EFORT Congress Berlin, May 23–26th., 2012

*Short and rewritten version of manuscript Clin Orthop Relat Res DOI 10.1007/s11999-013-2818-9

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Authors and Affiliations

  1. Faculty of Medicine, University of Bern, Walchstrasse 10, 3073, Guemligen, Switzerland

    Reinhold Ganz MD

  2. Orthopaedic Department, Inselspital, University of Bern, 3010, Bern, Switzerland

    Kai Ziebarth MD

  3. Orthopaedic Department, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Michael Leunig MD

  4. Department of Paediatric Surgery, Children’s Hospital, University of Bern, 3010, Bern, Switzerland

    Theddy Slongo MD

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

    Young-Jo Kim MD

Authors
  1. Reinhold Ganz MD
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  2. Kai Ziebarth MD
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  3. Michael Leunig MD
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  4. Theddy Slongo MD
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  5. Young-Jo Kim MD
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Correspondence to Reinhold Ganz MD .

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Editors and Affiliations

  1. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, United Kingdom

    George Bentley

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Ganz, R., Ziebarth, K., Leunig, M., Slongo, T., Kim, YJ. (2013). Anatomical Reconstruction of the Hip with SCFE, Justified by Pathophysiological Findings. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_10

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  • DOI: https://doi.org/10.1007/978-3-642-36149-4_10

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