Document Detail


The fate of hips that are not prophylactically pinned after unilateral slipped capital femoral epiphysis.
MedLine Citation:
PMID:  23283674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear.
QUESTIONS/PURPOSES: We therefore determined (1) the incidence of contralateral slips in patients with unilateral SCFE, (2) the rate of subsequent corrective surgery, and (3) the Harris hip score (HHS) and VAS pain score for hips that sustained a contralateral slip after unilateral pinning.
METHODS: We retrospectively reviewed 226 patients with unilateral SCFE at initial presentation between 1965 and 2005; of these, 133 met our inclusion criteria and were followed at least 2 years. Latest followup included examination and radiographs for 52 patients and HHS (without radiographs) and VAS pain score for 81 hips. Minimum followup was 2 years (median, 13 years; range, 2-43 years).
RESULTS: Of the 133 patients at risk for a subsequent slip, 20 patients developed a contralateral slip (15%). One patient developed avascular necrosis requiring arthroplasty, and another patient had a mild contralateral slip with disabling pain. For the 15 patients with contralateral slips and scores available, the mean HHS was 90 (range, 49-100) and the mean VAS pain score was 20 of 100. Six found the contralateral hip painful.
CONCLUSIONS: The contralateral slip sustained by the majority of patients was for the most part mild. However, nearly 1/3 of the contralateral slipped hips were painful. One patient has severe pain, and a second required THA for avascular necrosis after an unstable slip. These may have been preventable by prophylactic pinning.
LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Authors:
Yaser M K Baghdadi; A Noelle Larson; Rafael J Sierra; Hamlet A Peterson; Anthony A Stans
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-10     Completed Date:  2013-08-28     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2124-31     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Arthroplasty, Replacement, Hip
Biomechanical Phenomena
Bone Screws*
Chi-Square Distribution
Child
Child, Preschool
Disease Progression
Female
Femur Head Necrosis / etiology,  surgery
Hip Joint / physiopathology,  radiography,  surgery*
Humans
Male
Orthopedic Procedures / adverse effects,  instrumentation*
Osteotomy
Pain Measurement
Pain, Postoperative / etiology,  surgery
Postoperative Complications / etiology*,  physiopathology,  radiography,  surgery
Range of Motion, Articular
Reoperation
Retrospective Studies
Slipped Capital Femoral Epiphyses / physiopathology,  radiography,  surgery*
Time Factors
Treatment Outcome
Young Adult
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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