Austin Chen1, Ari Youderian2, Summer Watkins3, Prasad Gourineni4. 1. Department of Orthopaedic Surgery, University of Illinois Medical Center, Chicago, Illinois, U.S.A. 2. Illinois Bone & Joint Institute, Morton Grove, Illinois, U.S.A. 3. Division of Pediatric Orthopaedics, Advocate Children's Hospital, Oak Lawn, Illinois, U.S.A. 4. Division of Pediatric Orthopaedics, Advocate Children's Hospital, Oak Lawn, Illinois, U.S.A.. Electronic address: pgourineni@gmail.com.
Abstract
PURPOSE: To investigate the outcomes of arthroscopic femoral neck osteoplasty in patients with slipped capital femoral epiphysis (SCFE)-related impingement. METHODS: We retrospectively reviewed 37 consecutive patients (40 hips; 19 male and 18 female patients; age range, 10 to 19 years) with SCFE who underwent hip arthroscopy for femoral neck osteoplasty over a 4-year period. Six hips were excluded because of the severity of the slip or conversion to an open procedure. The preoperative and postoperative slip angle, alpha angle, and internal rotation in flexion were compared. Patients were evaluated for pain, functional limitations, and obligatory external rotation deformity (OERD) at each follow-up visit. The mean follow-up period was 22 months (range, 12 to 56 months). RESULTS: We analyzed the results of 34 hips. Adequate distraction could not be obtained initially in 7 hips. The labral and acetabular cartilage damage appeared to be from crushing and abrasion from the bony prominence of the neck. The goals of complete pain relief and correction of OERD were achieved in 88% of the hips. OERD and pain persisted in 2 hips, and 2 patients had residual pain despite good motion. There was a statistically significant improvement in alpha angle (from 88.22° and 56.91°, P < .0001) and internal rotation in flexion (from -21.53° to 10.28°, P < .0001) with intervention. CONCLUSIONS: Arthroscopic femoral neck osteoplasty is effective in decreasing pain, the alpha angle, and OERD in mild to moderate SCFE. Morbid obesity, scarring from previous surgery, and the presence of screws in the anterior neck presented challenges to the arthroscopic technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PURPOSE: To investigate the outcomes of arthroscopic femoral neck osteoplasty in patients with slipped capital femoral epiphysis (SCFE)-related impingement. METHODS: We retrospectively reviewed 37 consecutive patients (40 hips; 19 male and 18 female patients; age range, 10 to 19 years) with SCFE who underwent hip arthroscopy for femoral neck osteoplasty over a 4-year period. Six hips were excluded because of the severity of the slip or conversion to an open procedure. The preoperative and postoperative slip angle, alpha angle, and internal rotation in flexion were compared. Patients were evaluated for pain, functional limitations, and obligatory external rotation deformity (OERD) at each follow-up visit. The mean follow-up period was 22 months (range, 12 to 56 months). RESULTS: We analyzed the results of 34 hips. Adequate distraction could not be obtained initially in 7 hips. The labral and acetabular cartilage damage appeared to be from crushing and abrasion from the bony prominence of the neck. The goals of complete pain relief and correction of OERD were achieved in 88% of the hips. OERD and pain persisted in 2 hips, and 2 patients had residual pain despite good motion. There was a statistically significant improvement in alpha angle (from 88.22° and 56.91°, P < .0001) and internal rotation in flexion (from -21.53° to 10.28°, P < .0001) with intervention. CONCLUSIONS: Arthroscopic femoral neck osteoplasty is effective in decreasing pain, the alpha angle, and OERD in mild to moderate SCFE. Morbid obesity, scarring from previous surgery, and the presence of screws in the anterior neck presented challenges to the arthroscopic technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Authors: Bejan A Alvandi; Steven R Dayton; Matthew J Hartwell; Erik B Gerlach; Peter R Swiatek; John J Carney; Vehniah K Tjong Journal: Curr Rev Musculoskelet Med Date: 2022-08-02
Authors: K O Oduwole; D de Sa; J Kay; F Findakli; A Duong; N Simunovic; Y Yi-Meng; O R Ayeni Journal: Bone Joint Res Date: 2017-08-08 Impact factor: 5.853