Arthroscopic Treatment of Iatrogenic Slipped Capital Femoral Epiphysis Screw Impingement and Associated Hip Pathology

Background: Screw impingement is an infrequently reported sequelae following in situ pinning of a slipped capital femoral epiphysis, but it may result in significant bony and chondrolabral degeneration. Hip arthroscopy may offer the advantage of screw removal in a minimally invasive manner under direct visualization, as well as providing the opportunity for management of concomitant hip pathology. Indications: A healthy, active 27-year-old woman with right hip dysfunction secondary to screw impingement and concomitant chondrolabral pathology following previous in situ pinning of a slipped capital femoral epiphysis. Technique Description: The patient elected to undergo arthroscopic removal of hardware, osteochondroplasty, and management of hip labrum pathology. After the screw was localized, a 2.8-mm pin was inserted down the cannulated center of the screw to prevent intraarticular displacement during removal. The screw and washer were removed intact, and femoroplasty was performed to remove the reactive bone and resolve the cam-type impingement. Acetabuloplasty was then performed to remove pincer-type impingement and provide an appropriate rim of bone for labral reconstruction. The pathologic labrum was then debrided and reconstructed with a semitendinosus allograft. Results: There were no immediate complications following surgery. Surgical management led to resolution of the patient’s mechanical symptoms and provided pain relief, which allowed return to prior baseline level of function. Discussion/Conclusion: Symptomatic screws that impinge the osteochondral and soft tissue anatomy of the hip require removal. Historically, these screws have been removed by open, mini-open, or percutaneous techniques. This case demonstrates the advantages of arthroscopic removal, as it affords the surgeon the ability to perform a dynamic examination, safely remove the screw, and directly visualize and manage concomitant hip pathology that may not be otherwise be recognizable. Further studies will be required to determine the ability of this technique to more clearly illustrate long-term improvement in function and prevention of the development of osteoarthritis.

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Background Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10–14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. Methods Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. Results From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). Conclusion National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. Level of evidence III

Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

Objective: This study has investigated the amount of bone remodeling in patients with a slipped capital femoral epiphysis (SCFE) treated with in situ fixation until closure of the epiphysis and the factors affecting remodeling. Method: Patients who underwent surgery for SCFE between January 2010 and January 2015 were retrospectively screened: Twenty-four male and 7 female patients (mean age 12.6 ± 1.9 years) were included in the study. Gender, age, history, and laterality of trauma, duration of hip pain (acute, chronic, acute on chronic background), and hip radiographs were evaluated. The Southwick and alpha angles were measured, and the factors affecting remodeling were assessed. The statistical analyses were conducted using SPSS 25.0 (IBM Corp., Armonk, NY); 95% confidence levels were calculated and p < 0.05 was considered to indicate statistical significance. Results: The preoperative displacement angles measured on the anteroposterior and lateral radiographs were 15.03° ± 9.1° and 25.93° ± 14.1° and at the last follow-up they were 11.63° ± 8.7° and 21.6° ± 12.1°, respectively. The alpha angles measured on the lateral radiographs preoperatively and at the end of follow-up were 52.33° ± 11.6° and 47.87° ± 11.8°, respectively. Significant remodeling was reflected in the angles measured on the anteroposterior and lateral X-ray images. Greater preoperative displacement angle was associated with less remodeling. Conclusion: Preoperative displacement affects the degree of postoperative remodeling. In patients with severe epiphyseal displacement, open reduction is an option but in situ pinning should be considered in that it is less invasive and more physiological.

Mid-term results after in situ pinning and hip arthroscopy for mild slipped capital femoral epiphysis: a minimum five-year follow-up

Purpose In situ pinning of mild slipped capital femoral epiphysis (SCFE) results in an aspherical head–neck junction and arthroscopic osteochondroplasty can successfully correct the head–neck junction. However, whether the correction stays stable over at least five years remains unknown. Methods In a retrospective and consecutive series, 11 patients with a mean age of 12 years (range, 10 years to 15 years) were included. All patients were treated for mild SCFE with in situ pinning and staged hip arthroscopy correcting the head–neck junction. All patients were assessed clinically and radiographically (radiograph and magnetic resonance imaging (MRI)) pre-operatively, 12 weeks and at least five years’ post-operatively. Results The mean range of motion (ROM) for flexion and internal rotation was stable over time with 100° (sd 4) and 21° (sd 6), respectively at the last follow-up. The mean alpha angle decreased from pre-operative 64° (range 61° to 68°) to 12 weeks post-operative 49° (range 46° to 52°; p = 0.001) and stayed stable over time. New superficial cartilage damage on either the acetabular or femoral side was seen in each three patients. Progressive labral degeneration was present in two patients. Conclusion In situ pinning and staged hip arthroscopy for the correction of mild SCFE is safe, restores normal alpha angles and reveals stable morphological correction at mid-term follow-up. Furthermore, the clinical results were excellent with almost normalized internal hip rotation at mid-term follow-up in patients who had reached adulthood. However, there was some joint deterioration, but without negative impact on subjective and clinical outcome after at least five years. Level of evidence IV