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Our grandson lives in Minnesota and has the opportunity to get medical care at the Mayo Clinic for his hip. He has a condition called slipping epiphysis. They are recommending pinning the hip to keep it from getting worse. What do you think of this? Is it the right treatment?
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By "slipped epiphysis" you are probably referring to sipped capital femoral epiphysis (SCFE). SCFE is a condition that affects the growth center of the hip (the capital femoral epiphysis). This section of the joint actually slips backwards on the top of the femur (the thighbone).
SCFE affects the hip in teenagers between the ages of 12 and 16 most often. Cases have been reported as early as age nine years old. If untreated this can lead to serious problems in the hip joint later in life. Fortunately, the condition can be treated and the complications avoided or reduced if recognized early. Surgery is usually necessary to stabilize the hip and prevent the situation from getting worse.
The pinning procedure you mentioned is called in situ pinning and refers to a surgical procedure that is often used in early treatment. The surgeon uses a special type of real-time X-ray called fluoroscopy to stabilize the slipped epiphysis. The growth area is pinned in place where it has slipped to keep it from slipping further.
In situ pinning is used most often for children who have mild slips. More severe slips may require more extensive (corrective) surgical intervention. Studies show excellent results for in situ pinning of mild slips.
But the growth center (epiphysis) is not put back in its normal anatomic place. So there are some concerns and questions about how well this approach works. What happens years down the road when the growth center fuses in a nonanatomic (misaligned) position? The Mayo Clinic is actually spearheading studies to take a look at this.
Mayo surgeons are asking which children will benefit the most from in situ pinning? And who should have surgery early on to correct the deformity? Early reconstructive surgery is designed to prevent disabling hip pain and stiffness from early arthritis. Is there some way to predict early on who might end up with these complications?
Surgeons at the Mayo Clinic say there is a need to further understand SCFE and the results of current management while developing improved treatment techniques. But on the basis of their studies, they still use in situ pinning for mild SCFE. They save the realignment procedures for young adults with disabling symptoms.
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