Abstract
Aim:
Audit of the outcome of subcapital osteotomy for a series of cases of severe unstable slipped capital femoral epiphysis.
Method:
57 cases of unstable severe slipped capital femoral epiphysis were operated on by a single surgeon between 2000 and 2011. The procedure was performed through the anterior abductor sparing approach. Patients have been followed up prospectively and the results are presented at average follow up is 6.4 years with a minimum of 18 month follow to include all risks of avn.
Results:
There were 35 males (average age 13.85 years) and 22 females (average age 12.4 years). Three syndromic cases, 2 Trisomy 21 (with no avn) and one pituitary/corpus callosum agenesis (developed avn) were included.
5 patients (8.7%) developed avn, one syndromic, another with noted avn on pre-operative MRI and the third with partially healed growth plate. Excluding these patients the avn rate was 2/54 (3.7%). Re-operations were performed on the avn group including two head neck debridements and valgus osteotomy, one head neck debridement alone and one arthrodesis. One patient is awaiting debridement and valgus osteotomy. One patient developed chondrolysis and has had no intervention 6 years. 2 patients developed asymptomatic heterotopic bone ossification and the incidence of lateral cutaneous nerve symptoms was 35% none requiring intervention. Leg length difference was less than 1 cm in those patients who did not develop avn.
Conclusion:
This single surgeon audit shows lower risk of avn than and strengthens the argument for referral to specific centres for such conditions.
Level of evidence: IV
