title: Outcomes following subcapital osteotomy for severe slipped upper femoral epiphysis.
abstract: Slipped upper femoral epiphysis (SUFE) is the most common hip disorder to affect adolescents. Controversy exists over the optimal treatment of severe slips, with a continuing debate between in situ fixation versus corrective surgery. We present our experience in a series of 57 patients presenting with severe unilateral SUFE (defined > 50°) managed with a subcapital cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to our tertiary referral institution with a severe slip. The affected limb was rested in slings and springs before corrective surgery which was performed via an anterior Smith-Petersen approach. Radiographic analysis confirmed an improvement in mean head-shaft slip angle from 53.8(°) (standard deviation (SD) 3.2) pre-operatively to 9.1(°) (SD 3.1) post-operatively, with minimal associated femoral neck shortening. In total 50 (88%) patients were complication free at a mean follow-up of seven years (2.8 to 13.9 years, SD 3). Their mean Oxford hip score was 44 (37 to 48) and median visual analogue pain score was 0 out of 10 (interquartile range 0 to 4). A total of six patients (10.5%) developed avascular necrosis requiring further surgery and one (1.8%) patient developed chondrolysis but declined further intervention. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results in our tertiary centre.
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: I S
authors.initials: IS
authors.lastname: Vanhegan
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Cashman
authors.affiliation: Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: P
authors.initials: P
authors.lastname: Buddhdev
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hashemi-Nejad
mesh_terms: D000293:Adolescent; D002648:Child; D004838:Epiphyses / Q000000981:diagnostic imaging; D005260:Female; D057925:Femoracetabular Impingement / Q000209:etiology; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000528:radiation effects* / Q000601:surgery; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D060048:Slipped Capital Femoral Epiphyses / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Slipped upper femoral epiphysis; cuneiform osteotomy; outcome; realignment; severe slip