Risk factors for early symptomatic femoroacetabular impingement following in situ fixation of slipped capital femoral epiphysis |
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| Affiliation: | 1. Augusta University, 1446 Harper Street, Augusta, GA, 30912, USA;2. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA;3. Texas Children''s Hospital, 6701 Fannin Street, Houston, TX, 77030, USA;1. Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;2. William Beaumont Health System, Royal Oak, Michigan;3. Blue Cross Blue Shield of Michigan, Detroit, Michigan;4. St. John Providence Health System, Detroit, Michigan;5. Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan;6. University of Miami Health System, Miami, Florida;1. Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India;2. Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India;1. Canterbury Christ Church University, Faculty of Health and Social Sciences, Chatham Maritime, Kent, UK;2. Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;3. Department of Orthopaedics, Apollo Hospital, Muscat, Oman;4. Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, ME5 9PG, UK;5. Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria;1. Umraniye Health Sciences University Training and Research Hospital Department of Orthopaedics and Traumatology, Istanbul, Turkey;2. Tavsanlı State Hospital Department of Orthopaedics and Traumatology, Tavsanlı, Kütahya, Turkey;1. Professor, Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India;2. Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK;3. Consultant, GRIPMER, Sir Ganga Ram Hospital, New Delhi, India;4. Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India;5. Consultant Musculoskeletal Radiologist, Royal Orthopedic Hospital, Birmingham, UK |
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| Abstract: | In situ fixation of slipped capital femoral epiphysis (SCFE) results in residual deformity that can cause femoroacetabular impingement (FAI). It is unknown what factors could help differentiate patients who are more likely to become symptomatic. We performed a retrospective review of 55 hips treated with in situ pinning for SCFE and subsequent secondary deformity correction procedure for symptomatic FAI and compared them to 39 asymptomatic hips with SCFE deformity using multivariable analysis. Case patients were slightly older than controls (12.6 vs 11.3 years, p = 0.0002) but had similar BMI. The mean epiphyseal-diaphyseal angle was 56° in cases versus 44° in controls (p = 0.0019). Cases were significantly more likely to have obligate external rotation with hip flexion, external foot progression, flexion <90°, antalgic limp, and Trendelenburg lurch. On radiographs, most cases had a head-neck offset ≤0 mm, a distinct metaphyseal corner prominence, acetabular retroversion, and an alpha angle ≥60°. Most controls also had head-neck offset ≤0 mm. Pre-pinning, older age (OR = 1.98 per year, p = 0.0016) and initial epiphyseal-diaphyseal angle (OR = 1.04 per degree, p = 0.018) significantly increased the odds of having symptomatic FAI. Post-pinning, external foot progression increased the odds of symptomatic FAI by 10.48 (p = 0.017), and an alpha angle ≥60° resulted in 11.4 times higher odds of symptomatic FAI (p = 0.011). The linear correlation between epiphyseal-diaphyseal and alpha angle was poor (r = 0.28). Older age and initial epiphyseal-diaphyseal pre-pinning mildly increased the odds of eventual symptomatic FAI. This information can help the surgeon to predict which patients may develop symptomatic FAI. |
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| Keywords: | Slipped capital femoral epiphysis Femoroacetabular impingement |
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