Long-term functional and degenerative consequences of non treated slipped capital femoral epiphysis (SCFE), have been extensively demonstrated. At present, the treatment of SCFE is well described, however the treatment of the sequelae of SCFE, once osseous consolidation has happened, remains controversial.

Our aim is to describe an original technique of cuneiform osteotomy of the femoral neck through surgical hip dislocation for the treatment of sequelae of SCFE. Six hips were operated with sequelae of severe SCFE; average age of 15,2 years, whose consulting motivation was hip pain and severe limp. All of them, with bony consolidation of the femoral physis at the time of the consultation.

In all cases, it was performed a cuneiform osteotomy of femoral neck and replacement of the femoral epiphysis, through surgical hip dislocation. It was made a dissection and elevation of cervical periosteum to protect the epiphyseal vessels of the femoral head; then, the cuneiform osteotomy of the femoral neck is made with replacement of the femoral epiphysis to anatomical location and fixed.

The mean follow up was 21,2 months. We obtained consolidation in 100% of the cases, did not appear avascular necrosis nor other complications. An improvement was obtained according to Harris Hip Score from 37,6 points to 96,6. Correction of the epiphyseal-shaft angle was obtained from 62° to 12,6°.

This technique proposed in patients with sequel of SCFE is a good alternative of treatment, with good anatomical, functional, clinical and radiological results in young patients, without mid-term complications.

Objective: To evaluate if the complete resection of the femoral bump, in cam-type FAI increases the postoperative flexion and internal rotation.

Material and Method: We reviewed 24 consecutive pre-operative and postoperative hip CT scans in 24 patients with FAI (22 male and 2 female, mean age 36.9 years) who underwent arthroscopic hip surgery for the removal of a bony prominence on the femoral neck-head junction. We measured the alpha angle in two places: in the classical location, in the mid plane of the femoral neck axis and proximally, in the same plane but in first quarter of the femoral neck height. Then we compared these results with the presence of a residual prominence diagnosed in the 3 dimensionally reconstructed images of the postoperative CT scan and the virtual range of motion of the 3D models using impaction detection software.

Results: We found 7 cases with a residual bony prominence at the femoral neck-head junction in the 3D model of the proximal femur after the surgery. In this group the mean mid femoral neck alpha angle was significantly improved from 69.7° before the surgery to 48.3° (p=0.028), however the proximal alpha angle was not significantly improved 71.1° preoperative versus 62.7 (p=0.176) after the surgery. In the 17 patients without a residual bump, both alpha angles were improved, the mid alpha angle from 64.9° before the surgery to 40.76° (p=0.000) after the surgery and the proximal alpha angle from 65.8° to 38.4° (p=0.000). The range of motion of hip in the impaction detection software was also significantly improved in both groups, from flexion of 103° to 116° (p=0.001) in the group without a residual bump and from 102 to 118 (p=0.046) in the group with a residual bony prominence after the surgery. The internal rotation at 90° of flexion was also improved in both groups with a statistically significant difference (p=0.001 versus p=0.028 respectively).

Conclusion: The complete arthroscopic resection of the femoral bump improves significantly the ranges of flex-ion and internal rotation in patients with cam-type FAI.