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Outcomes after slipped capital femoral epiphysis: a population-based study with three-year follow-up.
Lund University, Department of Clinical Sciences, Lund, Sweden.
Futurum - Academy for Health and Care, Jonkoping County Council, Department of Orthopaedics, Ryhov County hospital, Jonkoping, Sweden.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.ORCID iD: 0000-0001-8596-6020
Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
2018 (English)In: Journal of Children's Orthopaedics, ISSN 1863-2521, E-ISSN 1863-2548, Vol. 12, no 5, p. 434-443Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate outcomes three years after treatment for slipped capital femoral epiphysis (SCFE): development of a vascular necrosis (AVN), subsequent surgery, hip function and the contralateral hip.

Methods: This prospective cohort study included a total national population of 379 children treated for SCFE between 2007 and 2013. A total of 449 hips treated for SCFE and 151 hips treated with a prophylactic fixation were identified. The Barnhöft questionnaire, a valid patient-reported outcome measure (PROM), was used.

Results: In all, 90 hips had a severe slip, 61 of these were clinically unstable. AVN developed in 25 of the 449 hips. Six of 15 hips treated with capital realignment developed AVN. A peri-implant femur fracture occurred in three slipped hips and in two prophylactically pinned hips. In three of these five hips technical difficulties during surgery was identified. In 43 of 201 hips scheduled for regular follow-up a subsequent SCFE developed in the contralateral hip. Implant extraction after physeal closure was performed in 156 of 449 hips treated for SCFE and in 51 of 151 prophylactically fixed hips. Children with impaired hip function could be identified using the Barnhöft questionnaire.

Conclusion: Fixation in situ is justified to remain as the primary treatment of choice in SCFE. Overweight is more common in children with SCFE than in the average population. Prophylactic fixation is a safe procedure when performed using a correct technique. The number of patients who developed AVN after capital realignment is of concern. We recommend rigorous follow-up of both hips, including PROM evaluation, until physeal closure.

Level of Evidence: II - prospective cohort study.

Place, publisher, year, edition, pages
British Editorial Society of Bone and Joint Surgery , 2018. Vol. 12, no 5, p. 434-443
Keywords [en]
complications, outcome, patient-reported outcome measures, slipped capital femoral epiphysis
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:hj:diva-42353DOI: 10.1302/1863-2548.12.180067ISI: 000446125800003PubMedID: 30294367OAI: oai:DiVA.org:hj-42353DiVA, id: diva2:1272522
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved

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