Moderate to severe slipped capital femoral epiphysis treated by surgical hip dislocation and subcapital realignment of epiphysis - case series

Abstract

ABSTRACT Background Slipped capital (upper)femoral epiphysis SCFE is a condition where the femoral epiphysis slips off of the proximal femoral neck. The deformity causes reduced range of motion and severe                   femoroacetabular impingement. Traditional methods of         correction have the consequence of recurrence of slippage, anatomic realign ment being not achieved, and development of secondary osteoarthritis. Subcapital realignment of            epiphysis involves surgical dislocation of hip and developing soft tissue flap consisting of retinaculum and external rotator muscles, which allows anatomic reduction of epiphysis,           preservation of perfusion of epiphysis and fusion of growth plate.Aim of study Purpose of study was to focus on outcome of moderate to severe slipped capital femoral epiphysis treated by safe surgical dislocation of hip and subcapital  realignment of epiphysis. Materials and methods Seven hips of 5 patients were surgically treated through approach of Ganz surgical hip dislocation and subcapital realignment of epiphysis. Patients were investigated with x-ray                       pelvis - anteroposterior view and frog leg lateral view. Post operatively passive mobilisation and abductor strengthening exercises were performed, gradual weight bearing allowed after 8 weeks. Operative results were followed up by periodic radiographs. Results Patients were followed for an average of 10 months (range, 3 to 18 months). Improvement in abduction and internal rotation were noted, have been able to walk  without crutches with no obvious limp. No occurance of          avascular necrosis of femoral head. Patients were satisfied with the function of hip joint. Conclusion Application of Ganz surgical dislocation of hip and subcapital realignment of epiphysis in treatment of moderate to severe SCFE is a valid alternative method. With this method anatomic realignment is achieved, blood supply is preserved, femoroacetabular          impingement is corrected and osteonecrosis of femoral head is prevented. Keywords Slipped capital femoral epiphysis, Ganz surgical dislocation, Subcapital realignment,                  Osteonecrosis