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Surgeons Advise Pinning Both Hips With Unilateral SCFE
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Posted on: 03/24/2008
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Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip in teenagers between the ages of 12 and 16. In this condition, the capital femoral epiphysis (growth center of the hip) slips backwards on the top of the femur (thighbone).
SCFE can occur in one or both hips. Sometimes it shows up on one side and later develops on the other side. Surgeons debate whether or not the second side should be pinned to prevent it from slipping as soon as the first hip develops SCFE.
Others argue this step isn't needed. The child can be watched carefully. That way an early slip will be recognized and treated right away. On the other hand, if there is a risk of a severe slip occurring, then preventive pinning may be a good idea.
In this study, surgeons at Children's Hospital of Philadelphia review the records of all children operated on for SCFE over a 10-year period. They made a note of the severity of the slips. Anyone with a unilateral (one-sided) slip was followed and observed for the development of another slip on the other side.
They found that more than one-third (36 per cent) of the children with unilateral SCFE developed bilateral (both sides) slips. The more severe the first slip, the greater the chance that a second slip would occur. Most second slips occurred within the first six months after the first slip.
And in moderate-to-severe cases, there was an increased risk of osteonecrosis (death of bone) and chondrolysis (degeneration of cartilage). Osteonecrosis resulted in collapse of the femoral head. Chondrolysis caused a narrowing of the joint space and a stiff joint.
Based on the results of this study, the authors advise prophylactic (preventive) pinning of the opposite hip in cases of unilateral SCFE. The unslipped hip can be pinned at the same time as the operation on the first hip.
This step is both safer and preferable to just observing and treating symptoms. The long-term risk of osteoarthritis may be prevented with early treatment and prophylaxis. It also reduces the number of X-rays needed to follow the patient. And the child can be more active without worrying about a second slip.
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References:
Yakup Yildirim, MD, et al. Chondrolysis, Osteonecrosis, and Slip Severity in Patients with Subsequent Contralateral Slipped Capital Femoral Epiphysis. In The Journal of Bone and Joint Surgery. March 2008. Vol. 90. No. 3. Pp. 485-492.
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