New method of corrective femoral osteotomy in children with slipped capital femoral epiphysis

Abstract

Introduction Extra-articular corrective rotational femoral osteotomies enable to completely restore or approximate to the normal the spatial position of the femoral epiphysis and its balance with the acetabulum in patients with most common types of slippage in moderate stable slipped capital femoral epiphysis (SCFE). Aim Evaluation of the effectiveness of a new corrective femoral osteotomy technique that excludes hip subluxation and bayonet deformity of the proximal femur during surgery in children with SCFE. Materials and methods Pre- and postoperative findings of clinical and radiographic examination of 80 patients aged from 11 to 15 years with most common types of moderate stable femoral epiphyseal slippage were analyzed. The technique of corrective femoral osteotomy developed which was applied in 40 patients (40 interventions) differs in spatial position of the rotation axis of the proximal femur and type of bone cut. Results Subluxation and bayonet deformity of the proximal femur in the affected joint were obtained in none of the 24 cases with a maximum anterior rotation of the proximal femur fragment (45°) operated with the new technique while with the Imhauser osteotomy, previously used in group 2, they were seen in eight and 12 out of 24 cases, respectively. Average postoperative follow-up period was four years (range, 2-7 years).Clinical examination and X-ray study after this surgery showed no signs of coxarthrosis in 38 out of 40 cases after two years, and in 9 cases out of 10 after six years. Conclusions New method of corrective femoral osteotomy avoids hip subluxation and bayonet deformity during the surgery of the proximal femur as well as reduces (or completely avoids) lower limb residual shortening. This technique is relatively simple, shorter in time and less invasive than previous modifications. It also prevents femoroacetabular impingement in many clinical cases.

Keywords

• hip joint
• slipped capital femoral epiphysis
• corrective femoral osteotomy
• femoral head subluxation
• femoroacetabular impingement