gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Ten-year Follow-up after prophylactic pinning of the contralateral and asymptomatic hip in unilateral slipped capital femoral epiphysis

Meeting Abstract

  • presenting/speaker Till Lerch - Inselspital, Universitätsklinik für Orthopädie, Bern, Switzerland
  • Kai Ziebarth - Inselspital Universitätsspital Bern, Abteilung für Kinderorthopädie und Kindertraumatologie, Klinik für Kinderchirurgie, Bern, Switzerland
  • Simon Steppacher - Inselspital, Universitätsklinik für Orthopädie, Bern, Switzerland
  • Moritz Tannast - Inselspital, Universitätsklinik für Orthopädie, Bern, Switzerland
  • Klaus Siebenrock - Inselspital, Universitätsklinik für Orthopädie, Bern, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT18-286

doi: 10.3205/18dkou687, urn:nbn:de:0183-18dkou6875

Veröffentlicht: 6. November 2018

© 2018 Lerch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Prophylactic pinning of the asymptomatic and contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) has recently gained popularity, however it still remains controversial. Understanding the long term outcome of the contralateral normal hip in unilateral SCFE is crucial in helping the decision making about prophylactic fixation. There is limited data about the mid-term and long-term clinical, functional and radiographic outcomes after prophylactic pinning.

Therefore, we sought to determine the minimum 10-year outcome (1) for hip pain and function (2) in terms of subsequent surgeries and the (3) radiographic outcome in terms of development of cam morphology and hip osteoarthritis following prophylactic pinning of the contralateral asymptomatic hip in patients treated for unilateral SCFE.

Methods: Thirty-six patients (19 males and 17 females) with a preoperative mean age of 13 ± 2 years (range 10-17) were followed for a minimum of 10 years (mean followup of 12 ± 2 years, range, 10 to 17 years) after prophylactic pinning. The medical records were retrospectively reviewed for demographics, hip motion and additional surgeries. Hip function and pain was assessed by the Harris hip scores and the Hip Disability and Osteoarthritis Outcome Score (HOOS). Most recent postoperative radiographs were evaluated for measurement of the alpha angle and minimum joint space width.

Results:

1.
Thirty-one patients (86%) had Harris hip scores equivalent to excellent function outcomes (>91 points). The mean Harris hip scores for the remaining 32 patients was 97 ± 5 (74-100). The mean scores for the HOOS was 94 ± 8 (71-100).
2.
Four out of the 36 (11%) patients underwent subsequent surgical treatment for femoroacetabular impingement (FAI).
3.
At the most recent radiograph, 72% of the patients had a normal configuration of the femoral head-neck junction. The mean alpha angle was 53 ± 8° (42-77) on the anteroposterior radiograph and 49 ± 8° (37-66) on the lateral view. A total of 10 out of 36 patients (28%) developed a cam morphology at the femoral head-neck junction. No patients had radiographic signs of osteoarthritis of the hip. The mean minimum joint space width was 4 ± 0.4 mm (3-5).

Conclusions: At minimum 10-year follow up after prophylactic pinning of the contralateral hip the vast majority of the patients can expect an excellent functional hip-specific outcome. However, patients with unilateral SCFE should still be considered to be at risk of developing cam FAI in the contralateral normal hip despite prophylactic fixation. Our findings showed that prophylactic pinning does not guarantee a life time impingement and pain free hip in all patients.