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Femoral Morphology Due to Impingement Influences the Range of Motion in Slipped Capital Femoral Epiphysis

  • Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Femoroacetabular impingement due to metaphyseal prominence is associated with the slippage in patients with slipped capital femoral epiphysis (SCFE), but it is unclear whether the changes in femoral metaphysis morphology are associated with range of motion (ROM) changes or type of impingement. We asked whether the femoral head-neck junction morphology influences ROM analysis and type of impingement in addition to the slip angle and the acetabular version. We analyzed in 31 patients with SCFE the relationship between the proximal femoral morphology and limitation in ROM due to impingement based on simulated ROM of preoperative CT data. The ROM was analyzed in relation to degree of slippage, femoral metaphysis morphology, acetabular version, and pathomechanical terms of “impaction” and “inclusion.” The ROM in the affected hips was comparable to that in the unaffected hips for mild slippage and decreased for slippage of more than 30°. The limitation correlated with changes in the metaphysic morphology and changed acetabular version. Decreased head-neck offset in hips with slip angles between 30° and 50° had restricted ROM to nearly the same degree as in severe SCFE. Therefore, in addition to the slip angle, the femoral metaphysis morphology should be used as criteria for reconstructive surgery.

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Acknowledgments

We thank Christoph Zilkens, MD and Marcel Dudda, MD for their help editing the manuscript and Carl P. Kolvenbach, MD for support in analysis of the data.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inselspital, University Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Tallal C. Mamisch MD

  2. Surgical Planning Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Radiology, Boston, MA, USA

    Tallal C. Mamisch MD, Jens A. Richolt MD & Jens Kordelle MD

  3. Department of Orthopedic Surgery, Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Young-Jo Kim MD, PhD & Michael B. Millis MD

  4. Department of Orthopaedic Surgery, University Frankfurt, Frankfurt am Main, Germany

    Jens A. Richolt MD

  5. Department of Orthopedic Surgery, University Giessen, Giessen, Germany

    Jens Kordelle MD

Authors
  1. Tallal C. Mamisch MD
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  2. Young-Jo Kim MD, PhD
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  3. Jens A. Richolt MD
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  4. Michael B. Millis MD
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  5. Jens Kordelle MD
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Corresponding author

Correspondence to Tallal C. Mamisch MD.

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Each author certifies that he or she has no 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.

Each author certifies that his or her institution has 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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Mamisch, T.C., Kim, YJ., Richolt, J.A. et al. Femoral Morphology Due to Impingement Influences the Range of Motion in Slipped Capital Femoral Epiphysis. Clin Orthop Relat Res 467, 692–698 (2009). https://doi.org/10.1007/s11999-008-0477-z

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  • DOI: https://doi.org/10.1007/s11999-008-0477-z

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