Surgical hip dislocation in treatment of slipped capital femoral epiphysis.
BACKGROUND
Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666-679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499-507].


OBJECTIVE
The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function.


METHODS
This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10-18 years). The mean follow-up period was 14.5 months (6-36 months).


RESULTS
Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip score (HHS) was (96.16 ± 9.7) and the mean improvement was (29.6 ± 9.6) (p = 0.0000).


CONCLUSIONS
The modified Dunn procedure allows to restore the normal proximal femoral anatomy by complete correction of the slip angle. This technique may reduce the probability of secondary osteoarthritis and femoroacetabular cam impingement.
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt - Turin University Hospitals "Centro Traumatologico Ortopedico Hospital", 10126 Turin, Italy - San Luigi hospital of Orbassano, 10043 Turin, Italy.
Mohammed
M
Elmarghany
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt.
Tarek M
TM
Abd El-Ghaffar
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt.
Mahmoud
M
Seddik
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt.
Ahmed
A
Akar
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt.
Yousef
Y
Gad
Orthopedic Department, Alazhar University Hospitals, Cairo 11675, Egypt.
Eissa
E
Ragheb
Turin University Hospitals "Centro Traumatologico Ortopedico Hospital", 10126 Turin, Italy - San Luigi hospital of Orbassano, 10043 Turin, Italy.
Alessandro
A
Aprato
Turin University Hospitals "Centro Traumatologico Ortopedico Hospital", 10126 Turin, Italy - San Luigi hospital of Orbassano, 10043 Turin, Italy.
Alessandro
A
Massè