Advances in hip preservation after slipped capital femoral epiphysis.

Overview

The metaphyseal deformity, in even a mild slipped capital femoral epiphysis (SCFE), results in acetabular labral and cartilage injury. SCFE is the most extreme form of femoroacetabular impingement, and the mechanism of cartilage and labral injuries is similar. Recent surgical advances for treating femoroacetabular impingement have made it possible to consider applying these techniques to the surgical treatment of SCFE deformities to lessen the risk of secondary osteoarthritis. The goals of treatment are to arrest slip progression and restore normal proximal femoral anatomy, thereby decreasing damage to the hip joint secondary to impingement. In situ pinning is the most effective treatment to halt short-term slip progression; outcomes are favorable in many hips. In medical centers with substantial experience with hip preservation techniques, open or arthroscopic osteochondroplasty can be used to treat mild SCFE, and a modified Dunn epiphyseal reorientation can be used for more severe deformities to decrease the potential for secondary osteoarthritis.