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International Orthopaedics

, Volume 43, Issue 10, pp 2375–2382 | Cite as

Moderate and severe SCFE (Slipped Capital Femoral Epiphysis) arthroscopic osteoplasty vs open neck osteotomy—a retrospective analysis of results

  • Balasubramanian Balakumar
  • Elinor Flatt
  • Sanjeev MadanEmail author
Original Paper

Abstract

Aim

We intend to compare the outcomes of arthroscopic osteoplasty with open neck osteotomy for correction of the hip impingement and improvement of hip function in children with moderate to severe healed Slipped Capital Femoral Epiphysis (SCFE). Our aim is to verify if arthroscopic osteoplasty could achieve the same outcome as open procedures.

Patients and methods

A retrospective analysis of the hospital hip database retrieved 187 cases of SCFE from 2006 to 2013. We found 12 patients underwent open neck osteotomy and deformity correction for moderate/ severe healed SCFE and ten underwent arthroscopic osteoplasty of the hip. We compared the outcomes between these groups.

Results

In the arthroscopy cohort, the mean age at surgery was 15.8 years (range 13–19 years) and mean follow-up was 46.1 months (range 33–66 months). In the neck osteotomy group, the mean age at surgery was 14.6 years (11–20 years) and mean duration of follow-up was 49 months (36–60 months). The outcomes in arthroscopic osteoplasty group vs. open neck osteotomy were as follows: antero-posterior (AP) slip angle 9.2° (0.3°- 28.8°) vs 10.8° (1°–17.9°) (p = 0.0003), lateral slip angle 44.8° (36.5°–64.2°) vs 13.5° (1°–28.5°) (p = 0.00001), oblique plane deformity 47.1° (40.2°–53.5°) vs 16.7° (1°–28.6°) (p = 0.0003), alpha angle 61.88° (52.1°–123°) vs.34.6° (23.2°–45.6°) (p = 0.0003), anterior offset 0 mm (0 mm–2 mm) vs. 5 mm (2–13 mm) (p = 0.0003), modified Harris hip score (MHHS) 75.5 (58.75–96.8) vs. 90 (86.2–99) (p = 0.003), non-arthroplasty hip score (NAHS) 67.12 (18.75–100) vs. 92.1 (81.25–100) (p = 0.002), internal rotation 20° (0–20°) vs. 50° (30°–70°) (p = 0.0002), respectively.

Conclusion

Even though the radiographic correction lagged behind in the arthroscopic group, the functional outcomes achieved did convey the gain of function in this cohort. In carefully selected cases, arthroscopy could be a less invasive procedure which has desirable outcomes.

Keywords

Slipped capital femoral epiphysis Arthroscopic osteoplasty Open neck osteotomy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional audit and ethical board had approved this study.

References

  1. 1.
    Compton S (2014) Childhood obesity and slipped capital femoral epiphysis. Radiol Technol 85(3):321CT–326CTPubMedGoogle Scholar
  2. 2.
    Thawrani DP, Feldman DS, Sala DA (2016) Current practice in the management of slipped capital femoral epiphysis. J Pediatr Orthop 36(3):e27–e37CrossRefGoogle Scholar
  3. 3.
    Bittersohl B, Hosalkar HS, Zilkens C, Krauspe R (2015) Current concepts in management of slipped capital femoral epiphysis. Hip Int 25(2):104–114CrossRefGoogle Scholar
  4. 4.
    Klit J, Gosvig K, Magnussen E, Gelineck J, Kallemose T, Søballe K et al (2014) Cam deformity and hip degeneration are common after fixation of a slipped capital femoral epiphysis. Acta Orthop 85(6):585–591CrossRefGoogle Scholar
  5. 5.
    Roy DR (2015) The use of hip arthroscopy in the management of the pediatric hip. J Hip Preserv Surg 3(2):97–107CrossRefGoogle Scholar
  6. 6.
    Balakumar B, Madan S (2016) Late correction of neck deformity in healed severe slipped capital femoral epiphysis: short-term clinical outcomes. Hip Int 26(4):344–349CrossRefGoogle Scholar
  7. 7.
    Tannast M, Jost LM, Lerch TD, Schmaranzer F, Ziebarth K, Siebenrock KA (2017) The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience. J Child Orthop 11(2):138–146CrossRefGoogle Scholar
  8. 8.
    Cooper AP, Salih S, Geddis C, Foster P, Fernandes JA, Madan SS (2014) The oblique plane deformity in slipped capital femoral epiphysis. J Child Orthop 8(2):121–127CrossRefGoogle Scholar
  9. 9.
    Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S (2016) Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. Bone Joint J 98–B(1):21–27CrossRefGoogle Scholar
  10. 10.
    Oduwole KO, de Sa D, Kay J, Findakli F, Duong A, Simunovic N et al (2017) Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis. Bone Joint Res 6(8):472–480CrossRefGoogle Scholar
  11. 11.
    Botser IB, Smith TW, Nasser R, Domb BG (2011) Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 27(2):270–278CrossRefGoogle Scholar
  12. 12.
    Mardones R, Lara J, Donndorff A, Barnes S, Stuart MJ, Glick J et al (2009) Surgical correction of “cam-type” femoroacetabular impingement: a cadaveric comparison of open versus arthroscopic debridement. Arthroscopy 25(2):175–182CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Balasubramanian Balakumar
    • 1
  • Elinor Flatt
    • 2
  • Sanjeev Madan
    • 3
    Email author
  1. 1.Department of Trauma and OrthopaedicsSheffield Children’s HospitalSheffieldUK
  2. 2.Doncaster Royal InfirmaryDoncasterUK
  3. 3.Centre for Hip PreservationSheffield Children’s Hospital NHS Foundation Trust and Doncaster Royal InfirmarySheffieldUK

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