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Effects of joint loading on the development of capital femoral epiphysis morphology

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The deleterious influence of increased mechanical forces on capital femoral epiphysis development is well established; however, the growth of the physis in the absence of such forces remains unclear. The hips of non-ambulatory cerebral palsy (CP) patients provide a weight-restricted (partial weightbearing) model which can elucidate the influence of decreased mechanical forces on the development of physis morphology, including features related to development of slipped capital femoral epiphysis (SCFE). Here we used 3D image analysis to compare the physis morphology of children with non-ambulatory CP, as a model for abnormal hip loading, with age-matched native hips.

Materials and methods

CT images of 98 non-ambulatory CP hips (8–15 years) and 80 age-matched native control hips were used to measure height, width, and length of the tubercle, depth, width, and length of the metaphyseal fossa, and cupping height across different epiphyseal regions. The impact of age on morphology was assessed using Pearson correlations. Mixed linear model was used to compare the quantified morphological features between partial weightbearing hips and full weightbearing controls.

Results

In partial weightbearing hips, tubercle height and length along with fossa depth and length significantly decreased with age, while peripheral cupping height increased with age (r > 0.2, P < 0.04). Compared to normally loaded (full weightbearing) hips and across all age groups, partially weightbearing hips’ epiphyseal tubercle height and length were smaller (P < .05), metaphyseal fossa depth was larger (P < .01), and posterior, inferior, and anterior peripheral cupping heights were smaller (P < .01).

Conclusions

Smaller epiphyseal tubercle and peripheral cupping with greater metaphyseal fossa size in partial weightbearing hips suggests that the growing capital femoral epiphysis requires mechanical stimulus to adequately develop epiphyseal stabilizers. Deposit low prevalence and relevance of SCFE in CP, these findings highlight both the role of normal joint loading in proper physis development and how chronic abnormal loading may contribute to various pathomorphological changes of the proximal femur (i.e., capital femoral epiphysis).

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Data availability

All data for this study are presented in the figures and in the body of the manuscript.

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Funding

Children’s Hospital Orthopaedic Surgery Foundation (AMK) and Boston Children’s Hospital Faculty Council (AMK).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Charles Mitchell, Koroush Emami, Alex Emami, Shayan Hosseinzadeh, Benjamin Shore, Eduardo N. Novais & Ata M. Kiapour

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  1. Charles Mitchell
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  2. Koroush Emami
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  3. Alex Emami
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  4. Shayan Hosseinzadeh
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  5. Benjamin Shore
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  6. Eduardo N. Novais
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  7. Ata M. Kiapour
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Contributions

Study concept and design was done by AMK, ENN, BS, SH, AE). Data collection and analysis was done by CFM, KE, AE, SH, and AMK). Interpretation of the findings was done by CFM, AE, SH, BS, ENN and AMK. First draft of the manuscript was developed by CFM, SH, and AMK. All co-authors contributed to the reviewing and finalizing the manuscript.

Corresponding author

Correspondence to Ata M. Kiapour.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Boston Children’s Hospital (IRB-P00015233).

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This a retrospective study and consent was not required as approved by the IRB.

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This a retrospective study and consent was not required as approved by the IRB.

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Mitchell, C., Emami, K., Emami, A. et al. Effects of joint loading on the development of capital femoral epiphysis morphology. Arch Orthop Trauma Surg 143, 5457–5466 (2023). https://doi.org/10.1007/s00402-023-04795-0

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  • DOI: https://doi.org/10.1007/s00402-023-04795-0

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