Prognostic significance of stability in slipped upper femoral epiphysis: a systematic review and meta-analysis.
OBJECTIVE
To examine associations of major complications after surgical treatment of slipped upper femoral epiphysis (SUFE) with condition- and treatment-related risk factors.


METHODS
This systematic review and meta-analysis of observational studies used an electronic literature search of Embase and Medline supplemented by a manual search of bibliographies. The studies enrolled children and adolescents with SUFE, defined stable and unstable disease, and reported at least 3 primary endpoints: avascular necrosis (AVN), chondrolysis, and reoperation. Random-effects meta-regression analysis was performed when possible.


RESULTS
The weighted risk for AVN, derived from intercept-only meta-regression, was estimated as 5.3% (95% confidence interval [CI], 3.4%-7.2%). Patients with unstable slips had a 9.4-fold greater risk of developing AVN. Instability proved to be an independent predictor for AVN. The weighted risk of chondrolysis was 0.8% (95% CI, 0.2%-1.4%), associated with unstable slips and osteotomies. The risk of reoperation was estimated at 5.5% (95% CI, 1.7%-9.3%). Loss of fixation was the primary reason for reoperation.


CONCLUSIONS
Current evidence indicates that unstable slips are at a significantly higher risk for AVN than stable slips, regardless of the attempted surgical approach. Little clinical information is available regarding chondrolysis and reoperation in relation to the stability of the physis.
Tosounidis
Theodoros
T
Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, University of Leeds, Leeds, UK.
Stengel
Dirk
D
Kontakis
George
G
Scott
Brian
B
Templeton
Peter
P
Giannoudis
Peter V
PV
D000293:Adolescent; D002648:Child; D004839:Epiphyses, Slipped / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D005269:Femur; D006621:Hip Joint; D006801:Humans; D007593:Joint Instability / Q000150:complications*; D019637:Orthopedic Procedures / Q000379:methods; D010020:Osteonecrosis / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors