In this study, surgeons from the Mayo Clinic (Rochester, Minnesota) evaluate the long-term results for patients who were treated for slipped capital femoral epiphysis (SCFE) with a treatment approach that was new 30 years ago. The treatment is called in situ pinning. In situ means "in position." In situ pinning has become an acceptable way to treat this hip problem but should be reviewed for success before continuing to use it.
Slipped capital femoral epiphysis (SCFE) is a condition that affects the growth center of the hip (the capital femoral epiphysis). This section of the joint actually slips backwards on the top of the femur (the thighbone).
SCFE affects the hip in teenagers between the ages of 12 and 16 most often. Cases have been reported as early as age nine years old. If untreated this can lead to serious problems in the hip joint later in life. Fortunately, the condition can be treated and the complications avoided or reduced if recognized early. Surgery is usually necessary to stabilize the hip and prevent the situation from getting worse.
In situ pinning refers to a surgical procedure that is often used in early treatment. The surgeon uses a special type of real-time X-ray called fluoroscopy to stabilize the slipped epiphysis. The growth area is pinned in place. But it is not put back in its normal anatomic place. So there are some concerns and questions about how well this approach works. What happens years down the road when the growth center fuses in a nonanatomic (misaligned) position?
That's where this study comes in. The surgeons observed that patients who had the in situ pinning still complained of persistent pain, stiffness, and difficulty with movement. This was true even when the slip was considered "mild."
Researchers reviewed the medical records (including X-rays) and telephoned 105 patients who had in situ pinning of the hip as children/teens. Patients were interviewed and completed surveys over the phone answering questions about pain, mental and physical health, and hip stiffness and dysfunction.
They gathered information about patients who had to have further surgery after the pinning procedure. The type of surgeries were reported (femoral osteotomy, surgical hip dislocation, total hip replacement). They also evaluated the data to find risk factors that might predict who would have ongoing pain and disability. Here's a quick summary of what they found:
A full third of all patients in their study who had in situ pinning still had significant hip pain.
In the first 10 years after the pinning procedure, one in 10 had to have additional surgery.
A smaller number of patients (five per cent) had severe enough symptoms from arthritis to warrant a total hip replacement.
A large number of those patients who developed arthritis had mild or moderate (not severe) SCFE.
A closer look at the data showed no predictive risk factors to help surgeons plan treatment for these patients. They simply don't know why a mild slip would result in such severe consequences for some patients after in situ pinning but not for all.
On the basis of these results, the Mayo surgeons still use in situ pinning for mild SCFE. They perform the realignment procedures on young adults with disabling symptoms. And they recommend further study to sort out who should have what treatment.
For example, which children will benefit the most from in situ pinning? And who should have surgery early on to correct the deformity? Early reconstructive surgery is designed to prevent disabling hip pain and stiffness from early arthritis. Is there some way to predict early on who might end up with these complications? There is a need to further understand SCFE and the results of current management while developing improved treatment techniques.
Reference: A. Noelle Larson, MD, et al. Outcomes of Slipped Capital Femoral Epiphysis Treated with In Situ Pinning. In The Journal of Pediatric Orthopaedics. March 2012. Vol. 32. No. 2. Pp. 125-130.