Arthroscopic subcapital realignment osteotomy in the treatment of chronic and stable proximal femoral epiphysiolysis: Early results

Bruno Dutra Roos, Marcelo Camargo de Assis, Milton Valdomiro Roos, Antero Camisa Júnior, Ezequiel Moreno Ungaretti Lima, Rodolfo Cavanus Pagani

Article ID: 1739
Vol 4, Issue 1, 2021

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Abstract


Objective: To evaluate the clinical and radiographic results and complications of arthroscopic subcapital realignment osteotomy for the treatment of chronic and stable proximal femoral epiphysiolysis (PFE) in an initial series of patients. According to the literature review, the study presents the first description of an arthroscopic technique of this type of osteotomy. Methods: Between June 2012 and December 2014, seven patients underwent arthroscopic subcapital realignment osteotomy for the treatment of chronic, stable PFE. The mean age of the patients was 11 years and four months. Minimum follow-up ranged from 6 to 36 months (mean, 16.5 months). Patients were clinically evaluated according to the Harris Hip Score modified by Byrd and radiographically according to Southwick’s quantitative classification and the epiphyseal-diaphyseal angle. Postoperative complications were analyzed. Results: With regard to the evaluation of the Harris Hip Score Modified by Byrd clinical score, a preoperative mean of 35.8 points and a postoperative mean of 97.5 points were observed (p < 0.05). Radiographically, five patients were classified as Southwick grade II and two as grade III. A mean correction of the epiphyseal-diaphyseal angle of 40° was observed. There were no immediate postoperative complications. One patient developed avascular necrosis of the femoral head, without collapse or chondrolysis at the last follow-up (22 months). Conclusion: The arthroscopic technique presented by the authors for the treatment of chronic, stable PFE resulted in clinical and radiographic improvement of the patients in this initial series.


Keywords


Displaced Epiphysis; Hip; Femoral Head; Arthroscopy; Child

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References


1. Lehmann CL, Arons RR, Loder RT, et al. The epidemiology of slipped capital femoral epiphysis: An update. Journal of Pediatric Orthopaedics 2006; 26(3): 286–290.

2. Leunig M, Casillas MM, Hamlet M, et al. Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthopaedica Scandinavica 2000; 71(4): 370–375.

3. Loder RT, Richards BS, Shapiro PS, et al. Acute slipped capital femoral epiphysis: The importance of physeal. The Journal of Bone and Joint Surgery 1993; 75(8): 1134–1140.

4. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery 1967; 49(5): 807–835.

5. Bellemans J, Fabry G, Molenaers G, et al. Slipped capital femoral epiphysis: A long-term follow-up, with special emphasis on the capacities for remodeling. Journal of Pediatric Orthopedics. Part B 1996; 5(3): 151–157.

6. Jones JR, Paterson DC, Hillier TM, et al. Remodelling after pinning for slipped capital femoral epiphysis. The Journal of Bone and Joint Surgery 1990; 72(4): 568–573.

7. Ziebarth K, Zilkens C, Spencer S, et al. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clinical Orthopaedics and Related Research 2009; 467(3): 704–716.

8. Sucato DJ, De La Rocha A. High-grade SCFE: The role of surgical hip dislocation and reduction. Journal of Pediatric Orthopaedics 2014; 34(1): S18–S24.

9. Guimarães RP, Alves DPL, Azuaga TL, et al. Tradução e adaptação transcultural do “Harris Hip Score modificado por Byrd” (Portuguese) [Translation and cross-cultural adaptation of the “Harris Hip Score modified by Byrd”]. Acta Ortopédica Brasileira 2010; 18(6): 339–343.

10. Roos BD, Roos MV, Camisa Júnior A, et al. Abordagem extracapsular para tratamento doimpacto femoroacetabular: resultados clínicos, radiográficose complicações (Portuguese) [Extracapsular approach for the treatment of femoroacetabular impingement: Clinical, radiographic and complicational results]. Revista Brasileira de Ortopedia 2015; 50(4): 430–437.

11. Sampson TG. Arthroscopic treatment of femoroacetabular impingement. Techniques in Orthopaedics 2005; 20(1): 56–62.

12. Sink EL, Zaltz I, Heare T, et al. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. Journal of Pediatric Orthopaedics 2010; 30(1): 26–30.

13. Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. The Journal of Bone and Joint Surgery 1964; 46(4): 621–629.

14. Dunn DM, Angel JC. Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis. The Journal of Bone and Joint Surgery 1978; 60(3): 394–403.

15. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip: A technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The Journal of Bone and Joint Surgery 2001; 83(8): 1119–1124.

16. Leunig M, Slongo T, Kleinschmidt M, et al. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Operative Orthopadie und Traumatologie 2007; 19(4): 389–410.

17. Sankar WN, Vanderhave KL, Matheney T, et al. The modified Dunn procedure for unstable slipped capital femoral epiphysis: A multicenter perspective. The Journal of Bone and Joint Surgery 2013; 95(7): 585–591.

18. Upasani VV, Matheney TH, Spencer SA, et al. Complications after modified Dunn osteotomy for the treatment of adolescent slipped capital femoral epiphysis. Journal of Pediatric Orthopaedics, 2014; 34(7): 661–667.

19. Akkari M, Santili C, Braga SR, et al. Trapezoidal bony correction of the femoral neck in the treatment of severe acute-on-chronic slipped capital femoral epiphysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2010; 26(11): 1489–1495.

20. Dobashi ET, Blumetti FC, Pinto JA, et al. Artroscopia do quadril na epifisiólise grave (Portuguese) [Hip arthroscopy in severe epiphysiolysis]. Revista Brasileira de Ortopedia 2010; 45: 59–62.




DOI: https://doi.org/10.24294/irr.v4i1.1739

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