More severe preoperative deformity found in cases of unstable slipped capital femoral epiphysis

SAN DIEGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed pediatric patients with unstable slipped capital femoral epiphysis presented with more severe preoperative deformity and had longer operative times.

“The unstable [slipped capital femoral epiphysis] SCFE patients seems to be less heavy and have more severe preoperative deformity than stable SCFEs,” Pamela Lang, MD, said in her presentation.

Lang and colleagues collected preoperative and postoperative clinical and radiographic information on 184 cases. Patients had a mean age of 11.9 years, and all SCFEs were treated with in-situ fixation. Researchers recorded the rate of complications, including avascular necrosis (AVN) and the need for secondary surgery, the presence of impingement and the final hip range of motion. Lang noted about 9% of patients had unstable SCFEs and 91% had stable SCFEs.

“Comparing the stable and unstable SCFEs, we found that the unstable SCFEs have significantly lower weight [and] significantly shorter time of symptoms prior to presentation; however, the severity of the slip was significantly higher in the unstable group,” Lang said.

Results showed a significantly longer surgical time for fixation in the unstable SCFE group, but no significant differences in range of motion between the stable and unstable SCFE groups. At final postoperative follow-up, radiographic impingement was more common among the unstable SCFE group. However, Lang said this did not reach statistical significance. Patients in the stable group underwent seven subsequent surgeries.

“There were four osteotomies done in total, one for AVN and three of them for impingement. I will note that there is one patient who had an unstable SCFE who is awaiting surgery,” Lang said. “Avascular necrosis was seen in 11% of the unstable SCFEs following pinning and 1% of the stable SCFEs.” – by Casey Tingle

Reference:

Delfosse EM, et al. Paper #641. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 14-18, 2017; San Diego.

Disclosure: Lang reports no relevant financial disclosures.