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Clinical Orthopaedics and Related Research®

Erschienen in:

01.12.2012 | Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History

verfasst von: Eduardo N. Novais, MD, Michael B. Millis, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2012

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Abstract

Background

Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term.

Questions/Purposes

We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment.

Methods

A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively.

Where Are We Now?

A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE.

Where Do We Need to Go?

Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes.

How Do We Get There?

Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.

Abraham E, Garst J, Barmada R. Treatment of moderate to severe slipped capital femoral epiphysis with extracapsular base-of-neck osteotomy. J Pediatr Orthop. 1993;13:294–302.PubMedCrossRef

Agamanolis DP, Weiner DS, Lloyd JK. Slipped capital femoral epiphysis: a pathological study. I. A light microscopic and histochemical study of 21 cases. J Pediatr Orthop. 1985;5:40–46.PubMedCrossRef

Allen CP, Calvert PT. Simultaneous slipped upper femoral epiphysis in identical twins. J Bone Joint Surg Br. 1990;72:928–929.PubMed

Aronson J, Tursky EA. The torsional basis for slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:37–42.PubMed

Barmada R, Bruch RF, Gimbel JS, Ray RD. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis. Clin Orthop Relat Res. 1978;132:98–101.PubMed

Bartonicek J, Vavra J, Bartoska R. Operative treatment of avascular necrosis of the femoral head after slipped capital femoral epiphysis. Arch Orthop Trauma Surg. 2011;131:497–502.PubMedCrossRef

Bellemans J, Fabry G, Molenaers G, Lammens J, Moens P. Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop B. 1996;5:151–157.PubMedCrossRef

Benson EC, Miller M, Bosch P, Szalay EA. A new look at the incidence of slipped capital femoral epiphysis in new Mexico. J Pediatr Orthop. 2008;28:529–533.PubMedCrossRef

Bhatia NN, Pirpiris M, Otsuka NY. Body mass index in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2006;26:197–199.PubMedCrossRef

10.

Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. 1981;63:85–95.PubMed

11.

Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1991;73:667–674.PubMed

12.

Chung SM, Batterman SC, Brighton CT. Shear strength of the human femoral capital epiphyseal plate. J Bone Joint Surg Am. 1976;58:94–103.PubMed

13.

Dodds MK, McCormack D, Mulhall KJ. Femoroacetabular impingement after slipped capital femoral epiphysis: does slip severity predict clinical symptoms? J Pediatr Orthop. 2009;29:535–539.PubMedCrossRef

14.

Dunbar J, Goulding A. Slipped capital femoral epiphysis: more New Zealand cases likely as obesity rises in children and adolescents? N Z Med J. 2001;114:559–560.PubMed

15.

Eisenstein A, Rothschild S. Biochemical abnormalities in patients with slipped capital femoral epiphysis and chondrolysis. J Bone Joint Surg Am. 1976;58:459–467.PubMed

16.

Engelhardt P. [Natural course of epiphysiolysis of the femur head] [in German]. Orthopade. 1994;23:195–199.PubMed

17.

Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.PubMedCrossRef

18.

Fahey JJ, O’Brien ET. Acute slipped capital femoral epiphysis: review of the literature and report of ten cases. J Bone Joint Surg Am. 1965;47:1105–1127.PubMed

19.

Falciglia F, Aulisa AG, Giordano M, Boldrini R, Guzzanti V. Slipped capital femoral epiphysis: an ultrastructural study before and after osteosynthesis. Acta Orthop. 2010;81:331–336.PubMedCrossRef

20.

Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. Proximal femoral physis shear in slipped capital femoral epiphysis—a finite element study. J Pediatr Orthop. 2006;26:291–294.PubMedCrossRef

21.

Fraitzl CR, Kafer W, Nelitz M, Reichel H. Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br. 2007;89:1592–1596.PubMedCrossRef

22.

Fraitzl CR, Nelitz M, Cakir B, Kafer W, Reichel H. [Transfixation in slipped capital femoral epiphysis: long-term evidence for femoro-acetabular impingement] [in German]. Z Orthop Unfall. 2009;147:334–340.PubMedCrossRef

23.

Futami T, Kasahara Y, Suzuki S, Seto Y, Ushikubo S. Arthroscopy for slipped capital femoral epiphysis. J Pediatr Orthop. 1992;12:592–597.PubMed

24.

Galbraith RT, Gelberman RH, Hajek PC, Baker LA, Sartoris DJ, Rab GT, Cohen MS, Griffin PP. Obesity and decreased femoral anteversion in adolescence. J Orthop Res. 1987;5:523–528.PubMedCrossRef

25.

Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.PubMedCrossRef

26.

Ganz R, Huff TW, Leunig M. Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009;58:241–255.PubMed

27.

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed

28.

Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am. 1986;68:1000–1007.PubMed

29.

Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997;79:1489–1497.PubMed

30.

Hagglund G, Hansson LI, Ordeberg G. Epidemiology of slipped capital femoral epiphysis in southern Sweden. Clin Orthop Relat Res. 1984;191:82–94.PubMed

31.

Imhauser G. [Late results of Imhauser’s osteotomy for slipped capital femoral epiphysis (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1977;115:716–725.PubMed

32.

Jones JR, Paterson DC, Hillier TM, Foster BK. Remodelling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg Br. 1990;72:568–573.PubMed

33.

Kelsey JL. Epidemiology of slipped capital femoral epiphysis: a review of the literature. Pediatrics. 1973;51:1042–1050.PubMed

34.

Kelsey JL, Acheson RM, Keggi KJ. The body build of patients with slipped capital femoral epiphysis. Am J Dis Child. 1972;124:276–281.PubMed

35.

Kitadai HK, Milani C, Nery CA, Filho JL. Wiberg’s center-edge angle in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 1999;19:97–105.PubMedCrossRef

36.

Kocher MS, Bishop JA, Weed B, Hresko MT, Millis MB, Kim YJ, Kasser JR. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics. 2004;113:e322–325.PubMedCrossRef

37.

Krahn TH, Canale ST, Beaty JH, Warner WC, Lourenco P. Long-term follow-up of patients with avascular necrosis after treatment of slipped capital femoral epiphysis. J Pediatr Orthop. 1993;13:154–158.PubMed

38.

Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics. 2003;112:424–430.PubMedCrossRef

39.

Larson AN, McIntosh AL, Trousdale RT, Lewallen DG. Avascular necrosis most common indication for hip arthroplasty in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:767–773.PubMedCrossRef

40.

Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. 2006;26:286–290.PubMedCrossRef

41.

Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–375.PubMedCrossRef

42.

Leunig M, Fraitzl CR, Ganz R. [Early damage to the acetabular cartilage in slipped capital femoral epiphysis. Therapeutic consequences] [in German]. Orthopade. 2002;31:894–899.PubMedCrossRef

43.

Leunig M, Horowitz K, Manner H, Ganz R. In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop Relat Res. 2010;468:3160–3167.PubMedCrossRef

44.

Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol. 2007;19:389–410.PubMedCrossRef

45.

Litchman HM, Duffy J. Slipped capital femoral epiphysis: factors affecting shear forces on the epiphyseal plate. J Pediatr Orthop. 1984;4:745–748.PubMedCrossRef

46.

Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop Relat Res. 1996;322:8–27.PubMed

47.

Loder RT. A worldwide study on the seasonal variation of slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:28–36.PubMed

48.

Loder RT, Aronson DD, Bollinger RO. Seasonal variation of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1990;72:378–381.PubMed

49.

Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. 1993;75:1141–1147.PubMed

50.

Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993;75:1134–1140.PubMed

51.

Loder RT, Starnes T, Dikos G, Aronsson DD. Demographic predictors of severity of stable slipped capital femoral epiphyses. J Bone Joint Surg Am. 2006;88:97–105.PubMedCrossRef

52.

Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop. 1995;15:349–356.PubMedCrossRef

53.

Lubicky JP. Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:162–167.PubMedCrossRef

54.

Mamisch TC, Kim YJ, Richolt JA, Millis MB, Kordelle J. Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis. Clin Orthop Relat Res. 2009;467:692–698.PubMedCrossRef

55.

Manoff EM, Banffy MB, Winell JJ. Relationship between body mass index and slipped capital femoral epiphysis. J Pediatr Orthop. 2005;25:744–746.PubMedCrossRef

56.

McPherson ME, Homer CJ. Policies to support obesity prevention for children: a focus on of early childhood policies. Pediatr Clin North Am. 2011;58:1521–1541.PubMedCrossRef

57.

Mickelson MR, Ponseti IV, Cooper RR, Maynard JA. The ultrastructure of the growth plate in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1977;59:1076–1081.PubMed

58.

Millis MB, Novais EN. In situ fixation for slipped capital femoral epiphysis: perspectives in 2011. J Bone Joint Surg Am. 2011;93(Suppl 2):46–51.PubMedCrossRef

59.

Mirkopulos N, Weiner DS, Askew M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Pediatr Orthop. 1988;8:268–273.PubMedCrossRef

60.

Morscher E. Strength and morphology of growth cartilage under hormonal influence of puberty. Animal experiments and clinical study on the etiology of local growth disorders during puberty. Reconstr Surg Traumatol. 1968;10:3–104.PubMed

61.

Murray AW, Wilson NI. Changing incidence of slipped capital femoral epiphysis: a relationship with obesity? J Bone Joint Surg Br. 2008;90:92–94.PubMed

62.

Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–824.PubMedCrossRef

63.

Nguyen AR, Ling J, Gomes B, Antoniou G, Sutherland LM, Cundy PJ. Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia. J Bone Joint Surg Br. 2011;93:1416–1423.PubMedCrossRef

64.

Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev. 2003;24:668–693.PubMedCrossRef

65.

Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29:1–8.PubMedCrossRef

66.

Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997;17:648–654.PubMedCrossRef

67.

Poussa M, Schlenzka D, Yrjonen T. Body mass index and slipped capital femoral epiphysis. J Pediatr Orthop B. 2003;12:369–371.PubMed

68.

Pritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop. 1988;8:385–388.PubMedCrossRef

69.

Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19:419–424.PubMed

70.

Rennie AM. The pathology of slipped upper femoral epiphysis. A new concept. J Bone Joint Surg Br. 1960;42:273–279.PubMed

71.

Restrepo R, Reed MH. Impact of obesity in the diagnosis of SCFE and knee problems in obese children. Pediatr Radiol. 2009;39(Suppl 2):S220–225.PubMedCrossRef

72.

Sankar WN, Brighton BK, Kim YJ, Millis MB. Acetabular morphology in slipped capital femoral epiphysis. J Pediatr Orthop. 2011;31:254–258.PubMedCrossRef

73.

Sankar WN, McPartland TG, Millis MB, Kim YJ. The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis. J Pediatr Orthop. 2010;30:544–548.PubMedCrossRef

74.

Schai PA, Exner GU, Hansch O. Prevention of secondary coxarthrosis in slipped capital femoral epiphysis: a long-term follow-up study after corrective intertrochanteric osteotomy. J Pediatr Orthop B. 1996;5:135–143.PubMedCrossRef

75.

Sink EL, Zaltz I, Heare T, Dayton M. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:26–30.PubMedCrossRef

76.

Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92:2898–2908.PubMedCrossRef

77.

Song KS, Oh CW, Lee HJ, Kim SD. Epidemiology and demographics of slipped capital femoral epiphysis in Korea: a multicenter study by the Korean Pediatric Orthopedic Society. J Pediatr Orthop. 2009;29:683–686.PubMedCrossRef

78.

Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49:807–835.PubMed

79.

Southwick WO. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. A technical improvement. J Bone Joint Surg Am. 1973;55:1218–1224.PubMed

80.

Stanitski CL, Woo R, Stanitski DF. Acetabular version in slipped capital femoral epiphysis: a prospective study. J Pediatr Orthop B. 1996;5:77–79.PubMedCrossRef

81.

Stanitski CL, Woo R, Stanitski DF. Femoral version in acute slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:74–76.PubMedCrossRef

82.

Steiner MM. Obesity with slipped femoral epiphysis. Case Rep Child Meml Hosp Chic. 1947;6:1017.PubMed

83.

Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Third Open Scientific Meeting of the Hip Society, St Louis, MO, USA: CV Mosby; 1975:212–228.

84.

Tosounidis T, Stengel D, Kontakis G, Scott B, Templeton P, Giannoudis PV. Prognostic significance of stability in slipped upper femoral epiphysis: a systematic review and meta-analysis. J Pediatr. 2010;157:674–680, 680–681.

85.

Weiner D. Pathogenesis of slipped capital femoral epiphysis: current concepts. J Pediatr Orthop B. 1996;5:67–73.PubMedCrossRef

86.

Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. 1993;13:610–614.PubMed

87.

Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467:704–716.PubMedCrossRef

Titel: Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History
verfasst von: Eduardo N. Novais, MD
Michael B. Millis, MD
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 12/2012
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2452-y

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Abstract

Background

Questions/Purposes

Methods

Where Are We Now?

Where Do We Need to Go?

How Do We Get There?

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