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Surgeons Find Tissue Injury in Stable Slipped Capital Femoral Epiphysis
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Posted on: 01/20/2010
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Some children develop a hip dislocation called a stable slipped capital femoral epiphysis. In cases like this, when a hip is dislocated, femoroacetabular inpingement, or too much friction in the hip joint, can cause damage, which can lead to degeneration. If a surgeon operates on this type of dislocation to pin the hip back into place, the surgery gives him or her the chance to see the joint clearly, to check for an friction or problems within the joint. The study described in this article describes and classifies the damage that may occur to the labrum (a ring of cartilage along the edge of the joint) and the acetabulum, the cup-shaped part of the joint that holds the head of the femur, or thigh bone.
Researchers looked at 39 hips from 36 patients (14 girls) that were operated on for stable slipped capital femoral epiphysis. On average, there was a 20-month period between when the patients dislocated the hip or hips and the surgery, ranging from six months to 28 months. The researchers graded the cartilage and labral injury acccording to their severity: mild (zero to 30 degrees); moderate (60 to 90 degrees), and severe (60 to 90 degrees). Eight were classified as mild, 20 as moderate, and 11 as severe.
The surgeons found that there was labral injury in 34 of the 39 hips and cartilage injury in 33 of the hips. The authors of this article describe some of the injuries that had completely eroded the tissue away as "a bucket handle tear." This damage was seen mostly at the rim of the acetabulum in the front and upper parts. Only one patient had neither type of injury. In patients who had previous surgery and already had pins in the joint, there was damage to the labrum from the head of the screw.When the researchers looked at how long the patients had their symptoms and how severe the injury was, they found no connection between this and the type labral or cartilage injury.
For the most part, the patients experienced at least partial relief after surgery, with many of them experiencing complete relief. The symptoms had included chronic anterior (front) pain that limited their activities, persistent (leg rotating outwards while walking), limited bending of the hip, and poor internal rotation (difficulty turning the leg inwards).
The authors concluded that injury to the tissue does occur when a patient has a slipped capital femoral epiphysis and this could contribute to joint degeneration later on.
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References:
Ernest L. Sink, MD, et al. Acetabular Cartilage and Labral Damage Observed During Surgical Hip Dislocation for Stable Slipped Capital Femoral Epiphysis. In Journal of Pediatric Orthopaedics. January/February 2010. Vol. 30. No. 1. Pp. 31 to 36.
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