Controversy remains as to whether the contralateral hip should be fixed in patients presenting with unilateral slipped capital femoral epiphysis (SCFE). This study compares the outcomes of those patients who had prophylactic fixation with those who did not. We identified 90 consecutive patients with a mean age of 12.3 years presenting to the study centre with SCFE from a prospective operative database. The patient's notes and radiographs were retrospectively analysed for post-operative complications, re-presentation with a contralateral slip, and the presence of a cam lesion. The mean length of follow-up was 8 years (range 3 to 13). Fifty patients (56%) underwent unilateral fixation and 40 patients underwent bilateral fixation, of which 4 (4%) patients had simultaneous bilateral SCFE and 36 (40%) had prophylactic fixation of the contralateral hip. Twenty-three patients (46%) that underwent unilateral fixation, went onto have contralateral fixation for a further SCFE. Two patients from this group had symptomatic femoracetabular impingement from cam lesions and one patient required a Southwick osteotomy for a severe slip. Five patients (10%) that had unilateral fixation only demonstrated cam lesions on radiographic analysis, being suggestive of an asymptomatic slip. No post-operative complications were observed for the contralateral hip in patients that had prophylactic screw fixation and no cam lesions were identified on radiographic assessment. This study suggests that the contralateral hip in patients presenting with unilateral SCFE should be routinely offered prophylactic fixation to avoid a further slip, which may be severe, and the morbidity associated with a secondary cam lesion

The June 2013 Hip & Pelvis Roundup³⁶⁰ looks at: failure in metal-on-metal arthroplasty; minimal hip approaches; whether bisphosphonates improve femoral bone stock following arthroplasty; whether more fat means more operative time; surgical infection; vascularised fibular graft for osteonecrosis; subclinical SUFE; and dentists, hips and antibiotics.

The reported prevalence of an asymptomatic slip of the contralateral hip in patients operated on for unilateral slipped capital femoral epiphysis (SCFE) is as high as 40%. Based on a population-based cohort of 2072 healthy adolescents (58% women) we report on radiological and clinical findings suggestive of a possible previous SCFE. Common threshold values for Southwick’s lateral head–shaft angle (≥ 13°) and Murray’s tilt index (≥ 1.35) were used. New reference intervals for these measurements at skeletal maturity are also presented.

At follow-up the mean age of the patients was 18.6 years (17.2 to 20.1). All answered two questionnaires, had a clinical examination and two hip radiographs.

There was an association between a high head–shaft angle and clinical findings associated with SCFE, such as reduced internal rotation and increased external rotation. Also, 6.6% of the cohort had Southwick’s lateral head–shaft angle ≥ 13°, suggestive of a possible slip. Murray’s tilt index ≥ 1.35 was demonstrated in 13.1% of the cohort, predominantly in men, in whom this finding was associated with other radiological findings such as pistol-grip deformity or focal prominence of the femoral neck, but no clinical findings suggestive of SCFE.

This study indicates that 6.6% of young adults have radiological findings consistent with a prior SCFE, which seems to be more common than previously reported.

Cite this article: Bone Joint J 2013;95-B:452–8.