Abstract
Introduction: The management of severe slipped upper femoral epiphysis (SUFE) is controversial. Many types of operation have been advocated. The cuneiform osteotomy offers the potential to restore normal anatomy and hence reduce the development of osteoarthritis, but it is not without its risks. This aim of this study was to quantify the long-term clinical & radiological results of Fish’s cuneiform osteotomy at skeletal maturity.
Method: Twenty-seven patients underwent a cuneiform osteotomy between 1990 – 2003. Two patients were lost to follow-up. Therefore 25 hips in 24 patients were reviewed at a mean follow-up of 8 years and 3 months. The mean slip angle was 77 ± 13 degrees and all were categorized as unstable. Sex distribution was equal and the average age at follow-up was 21.5 years (range 14 – 31 years). The Iowa hip-rating, Harris Hip Score and radiographic classification of degenerative joint disease according to Boyer et al.,1 were determined at follow-up.
Results: The mean Iowa hip-rating at follow-up was 93.7 ± 7.7 with a mean range of motion score of 8.1 ± 1.8. The Harris Hip Score was 95.6 ± 5.9. Nineteen patients were classified as Grade 0 on Boyer’s radiographic assessment, four Grade 1 and two Grade 2. Correction to neutral ± 10 degrees was achieved in all patients. The rate of avascular necrosis was 12 % and chondrolysis 16 %.
Discussion: Cuneiform osteotomy for severe SUFE is a valid treatment option and complication rates were no higher than other operative interventions reported in the literature. Patients enjoyed an excellent range of motion and were extremely satisfied with the outcome. The restoration of anatomy equates to better function and possibly the delay in onset of osteoarthritis.
Mr James Robb – BSCOS Honorary Secretary, Mr Geoffrey Mill – Host of the meeting, Mr Robin Paton – Editorial Secretary. Correspondence should be sent to BSCOS, c/o Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London, WC2A 3PN.
