Allograft epiphysiodesis for slipped capital femoral epiphysis.
During this retrospective investigation, use of freeze-dried irradiated allograft for achieving epiphysiodesis in patients with Grade I or Grade II slipped capital femoral epiphyses was evaluated. The study reviewed 40 grafting procedures in 33 patients: 20 patients were boys and 13 were girls, whose average age was 13 years old. The group included 31 Grade I slips and 9 Grade II slips. Six were unstable and 34 were stable. Procedure time averaged 1 hour 57 minutes and blood loss averaged 360 ml. The average time to complete physeal closure was 28 weeks. An incomplete bony physeal bridge, apparent at an average 11 weeks, may impart earlier stability. Thirty-eight cases had followup averaging 3 years 6 months. At most recent evaluation, according to the Harris hip rating system, 35 hips had excellent ratings, 1 had a good rating, and 2 had fair ratings. Six patients were identified with major postoperative complications, including 1 case each of segmental avascular necrosis, chondrolysis, femoral neck fracture, subtrochanteric hip fracture, bilateral progressive coxa vara deformities requiring corrective osteotomies, and a unilateral progressive coxa vara deformity. The senior author (TLS) currently uses a fluoroscopically guided percutaneous lateral approach, a cannulated reaming system, and freeze-dried irradiated cortical allograft. The procedure promotes premature physeal closure. Allograft epiphysiodesis is an alternative operating technique for treating patients with a slipped capital femoral epiphysis.
Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
T L
TL
Schmidt
W G
WG
Cimino
F G
FG
Seidel
D000293:Adolescent; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002357:Cartilage Diseases / Q000209:etiology; D002648:Child; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005265:Femoral Neck Fractures / Q000209:etiology; D005270:Femur Head / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D014184:Transplantation, Homologous