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In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty.

Description of Techniques

Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access was obtained and head-neck osteoplasty was completed.

Methods

Between March 2008 and August 2009, three male patients (age range, 11–15 years; BMI, 22–31 kg/m2) presented with slip angles between 15º and 30º. All were ambulatory without assistance but had 2 to 12 weeks of hip and/or knee pain, limited motion and a positive impingement test. Postoperatively, patients were assessed at 6 weeks; 3 and 6 months; then every 6 months for the first two years. Hip motion, epiphyseal-metaphyseal offsets and alpha angles were determined. Patients completed the UCLA activity scale at latest followup that ranged from 6 to 23 months.

Results

Arthroscopic evaluation revealed labral fraying, acetabular chondromalacia, and a prominent metaphyseal ridge. At last followup, each was pain-free and had returned to unrestricted activities. Hip motion improved in all and none demonstrated clinical impingement. Radiographs showed normalized epiphyseal-metaphyseal offsets and alpha angles.

Conclusions

In situ pinning with arthroscopic osteoplasty can limit impingement after mild slipped capital femoral epiphysis. Due to limited followup, we are unable to say whether this protocol reduces subsequent articular damage. Although we recommend performing these procedures concomitantly, they can be performed in a staged fashion, especially since hip arthroscopy following an epiphyseal slip can be challenging.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgements

We thank James Voos, M.D. for his contribution to the design of this study and to the initial preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Schulthess Clinic, Zürich, Switzerland

    Michael Leunig MD, Kevin Horowitz MD & Hannes Manner MD

  2. University of Berne, Berne, Switzerland

    Michael Leunig MD & Reinhold Ganz MD

  3. Department of Orthopaedic Surgery, Baylor College of Medicine, 6701 Fannin Street, CC 670.01, Houston, TX, 77030, USA

    Kevin Horowitz MD

Authors
  1. Michael Leunig MD
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  2. Kevin Horowitz MD
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  3. Hannes Manner MD
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  4. Reinhold Ganz MD
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Corresponding author

Correspondence to Kevin Horowitz MD.

Additional information

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 approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Department of Orthopedics, Schulthess Clinic, Zürich, Switzerland.

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Leunig, M., Horowitz, K., Manner, H. et al. In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report. Clin Orthop Relat Res 468, 3160–3167 (2010). https://doi.org/10.1007/s11999-010-1408-3

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  • DOI: https://doi.org/10.1007/s11999-010-1408-3

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