The February 2024 Children’s orthopaedics Roundup³⁶⁰ looks at: Hip impingement after in situ pinning causes decreased flexion and forced external rotation in flexion on 3D-CT; Triplane ankle fracture patterns in paediatric patients; Improved forearm rotation even after early conversion to below-elbow; Selective dorsal rhizotomy and cerebral palsy (CP) hip displacement; Abduction bracing following anterior open reduction for developmental dysplasia of the hip does not improve residual dysplasia or reduce secondary surgery; 40% risk of later total hip arthroplasty for in situ slipped capital femoral epiphysis (SCFE) pinning; Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage?; Waterproof hip spica casts for paediatric femur fractures.

The December 2023 Children’s orthopaedics Roundup³⁶⁰ looks at: A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants; How common are refractures in childhood?; Femoral nailing for paediatric femoral shaft fracture in children aged eight to ten years; Who benefits from allowing the physis to grow in slipped capital femoral epiphysis?; Paediatric patients with an extremity bone tumour: a secondary analysis of the PARITY trial data; Split tibial tendon transfers in cerebral palsy equinovarus foot deformities; Liposomal bupivacaine nerve block: an answer to opioid use?; Correction with distal femoral transphyseal screws in hemiepiphysiodesis for coronal-plane knee deformity.

Aims

We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years.

Aims

The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate.

Aims

Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide.

Aims

The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE).

Aims

The Patient-Reported Outcomes Measurement Information System (PROMIS) has demonstrated faster administration, lower burden of data capture and reduced floor and ceiling effects compared to traditional Patient Reported Outcomes Measurements (PROMs). We investigated the suitability of PROMIS Mobility score in assessing physical function in the sequelae of childhood hip disease.

Aims

Highly cross-linked polyethylene (HXLPE) has greatly improved the durability of total hip arthroplasty (THA) in young patients because of its improved wear characteristics. Few studies have followed this population into the second decade, and therefore the purpose of this investigation was to evaluate the clinical outcome for THA patients 50 years of age and younger at a minimum of 15 years postoperatively. The second purpose was to evaluate the radiological findings secondary to wear or mechanical failure of the implant.

Slipped capital femoral epiphysis (SCFE) is traditionally treated with in situ fixation using a threaded screw, leading to physeal arrest while stabilizing the femoral head. Recently, there has been interest in alternative methods of fixation for SCFE, aiming to allow growth and remodelling of the femoral neck postoperatively. One such option is the Free Gliding SCFE Screw (Pega Medical), which employs a telescopic design intended to avoid physeal compression. The objective of this study is to evaluate radiographic changes of the proximal femur following in situ fixation using the Free Gliding SCFE Screw. This study retrospectively evaluated 28 hips in 14 consecutive patients who underwent in situ hip fixation using the Free Gliding SCFE Screw between 2014 and 2018. Initial postoperative radiographs were compared to last available follow-up imaging. Radiographic assessment included screw length, articulotrochanteric distance (ATD), posterior sloping angle (PSA), alpha angle, head-neck offset (HNO) and head-shaft angle (HSA). Of the 28 hips reviewed, 17 were treated for SCFE and an additional 11 treated prophylactically. Average age at surgery was 11.7 years, with an average follow-up of 1.44 years. Screw length increased by 2.3 mm (p < 0.001). ATD decreased from 25.4 to 22.2 mm (p < 0.001). Alpha angle decreased from 68.7 to 59.8 degrees (p = 0.004). There was a trend towards an increase in HNO (p = 0.07). There was no significant change in PSA or HAS. There were three complications (two patients with retained broken guide wires, and one patient requiring screw removal for hip pain). With use of the Free Gliding SCFE Screw, there was evidence of screw expansion and femoral neck remodelling with short-term follow-up. More research is required to determine the long-term impact of these changes on hip function, and to aid in patient selection for this technology

Background. Slipped capital femoral epiphysis (SCFE) creates a complex deformity of the hip that can result in cam type of femoroacetabular impingement (FAI), which may in turn lead to the early development of osteoarthritis of the hip. The purpose of this study was to evaluate the existing literature reporting on the efficacy of hip arthroscopic treatment of patients with FAI secondary to SCFE. Methods. A systematic computer search was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 2019. Data such as patient demographics, surgical outcomes and complications that described arthroscopic surgery following FAI secondary to SCFE were retrieved from eligible studies. Two authors independently reviewed study inclusion and data extraction with independent verification. Results. Following filtration, seven studies were included in this review comprising 96 patients (100 hips). The mean age was 14.9 years (SD, 2.7), and 54.2% of the cases were male. Eighty seven percent patients had undergone previous procedures at the first diagnosis of SCFE. Slip severity at the time of performing hip arthroscopy was mild for 54%, moderate for 31% and severe deformity for 15%. The mean alpha angle corrections was 32.0° (SD, 6.0°), and the mean improvement of internal rotation angle at 90° flexion was 23.6° (sd, 9.5°). ModifiedHarris Hip Scores (mHHS) was most reported (n = 3 studies; 38 hips) of the clinical outcomes, and the mean improvement of mHHS was 22.0 (sd, 3.6). Complication rates were 10%, and revision rate was 6.0%. Conclusion. Patients with FAI secondary to SCFE undergoing arthroscopic treatment demonstrate improved improvement in clinical outcome, rotation of the hip and correction of the alpha angle. It remains to be seen whether this eventually leads to prevention of OA and avoiding arthroplasty in this group of patients

Aims. Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods. The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion. This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study

Aims

The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.

Aims

The aims of this study were to evaluate the abductor function in moderate and severe slipped capital femoral epiphysis (SCFE), comparing the results of a corrective osteotomy at the base of the femoral neck and osteoplasty with 1) in situ epiphysiodesis for mild SCFE, 2) contralateral unaffected hips, and 3) hips from healthy individuals.

Aims

This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA).

Slipped capital femoral epiphysis (SCFE) is associated with a spectrum of proximal femoral deformity and femoroacetabular impingement (FAI). Little attention has been given, however, to the possible effect of SCFE on remaining hip growth. Our observation that some acetabula in hips with SCFE have various dysmorphology led us to evaluate the growth of the hip in our patients with SCFE. We performed an IRB-approved retrospective study of our intramural SCFE database which identified 108 hips with unilateral SCFE, at least 2 years of radiographic followup, and closure of triradiate cartilage, greater trochanter and proximal femoral physis. The contralateral non-SCFE hip was used as control. Average age at presentation was 12.3 y. 49 patients were male, 59 female. Statistically significant differences were noted between SCFE and control hip both at both presentation and last followup(FU): Mean LCEA lower in SCFE hip at presentation by 0.97 degree; increasing to 4.36 degrees at last FU(p<0.0001). No difference noted in mean Tonnis roof angle at presentation, but at last FU SCFE hips had mean roof angle difference of 3.2 degrees higher than control(p<.0001). In some of our SCFE patients, acetabular deformity has impacted treatment. Ongoing studies may clarify risk factors for the development of problematic acetabular deformity associated with SCFE and perhaps allow prevention of secondary acetabular deformity