Authors: Kai Ziebarth Michael Leunig Theddy Slongo YoungJo Kim Reinhold Ganz
Publish Date: 2013/02/09
Volume: 471, Issue: 7, Pages: 2156-2162
Abstract
Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis SCFE As a result most pathophysiological information about the articular surfaces was derived clinically and radiographically Novel insights regarding deformityinduced damage and epiphyseal perfusion became available with surgical hip dislocationWe 1 determined the influence of chronicity of prodromal symptoms and severity of SCFE deformity on severity of cartilage damage 2 In surgically confirmed disconnected epiphyses we determined the influence of injury and time to surgery on epiphyseal perfusion and 3 the frequency of new bone at the posterior neck potentially reducing perfusion during epimetaphyseal reductionWe reviewed 116 patients with 119 SCFE and available records treated between 1996 and 2011 Acetabular cartilage damage was graded as +/++/+++ in 109 of the 119 hips Epiphyseal perfusion was determined with laserDoppler flowmetry at capsulotomy and after reduction Information about bone at the posterior neck was retrieved from operative reportsNinetyseven of 109 hips 89 had documented cartilage damage severity was not associated with higher slip angle or chronicity disconnected epiphyses had less damage Temporary or definitive cessation of perfusion in disconnected epiphyses increased with time to surgery posterior bone resection improved the perfusion In one necrosis the retinaculum was ruptured two were in the group with the longest time interval Posterior bone formation is frequent in disconnected epiphyses even without prodromal periodsAddressing the cause of cartilage damage cam impingement should become an integral part of SCFE surgery Early surgery for disconnected epiphyses appears to reduce the risk of necrosis Slip reduction without resection of posterior bone apposition may jeopardize epiphyseal perfusionEach author certifies that he or she or a member of his or her immediate family has no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted articleEach author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained
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