Strategies in Trauma and Limb Reconstruction

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VOLUME 12 , ISSUE 1 ( April, 2017 ) > List of Articles

Original Article

Femoral shaft osteotomy for obligate outward rotation due to SCFE

P. M. Stevens, Lucas Anderson, Bruce A. MacWilliams

Keywords : Slipped capital femoral epiphysis, SCFE, Femoral retroversion, FAI, Femoroacetabular impingement, Femoral osteotomy

Citation Information : Stevens PM, Anderson L, MacWilliams BA. Femoral shaft osteotomy for obligate outward rotation due to SCFE. 2017; 12 (1):27-33.

DOI: 10.1007/s11751-017-0276-8

License: CC BY-NC-SA 4.0

Published Online: 01-06-2015

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Slipped capital femoral epiphysis (SCFE) is an adolescent disease that leads to retroversion of the femoral neck and shaft, relative to the head. Observing that patients with SCFE must walk with an outward foot progression angle and externally rotate the leg in order to flex the hip, we have been performing a femoral shaft rotational osteotomy wherein we rotate the lower femur 45° inward, relative to the upper femur. By correcting retroversion, our goal is to improve functional hip and knee motion, thereby mitigating the effects of SCFE impingement. This is a retrospective review of five hips in four patients (two boys and two girls), average age 14.7 years (range 11 + 7–18 years) who underwent femoral midshaft rotational osteotomy for correction of acquired retroversion of the femur secondary to severe SCFE. We compared clinical findings at the outset to those at an average follow-up of 46 months (range 24–74 months). Pre- and post-gait analysis was performed in three patients. Two of the patients underwent elective arthroscopic osteochondroplasty to alleviate residual FAI: contralateral arthroscopy is pending in one. The first patient in this series received a hip arthroplasty, 62 months after his osteotomy, at age 23. Following midshaft osteotomy, all patients experienced improvement in comfort, gait and activities of daily living. With the patella neutral, they had improved range of hip flexion from an average preoperative flexion of <25° to a postoperative flexion of >90°. Two patients (both male) had delayed union and some loss of correction, secondary to broken interlocking screws; each healed with reamed, exchange nailing. The interlocking screws have since been redesigned and enlarged. Femoral shaft rotational osteotomy restores the functional range of hip motion, while correcting obligate out-toeing and improving knee kinematics. This procedure is technically straightforward, permitting progressive weight bearing, while avoiding the risk of AVN. Osteochondroplasty for residual FAI can be deferred, pending the outcome. Level of evidence III: retrospective series—no controls.


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  1. Abraham E, Gonzalez MH, Pratap S, Amirouche F, Atluri P, Simon P (2007) Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop 27:788-795. doi:10.1097/BPO.0b013e3181558c94
  2. Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR (1997) Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 79:1489-1497
  3. Leunig M, Slongo T, Kleinschmidt M, Ganz R (2007) Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol 19:389-410. doi:10.1007/s00064-007-1213-7
  4. Schwartz MH, Rozumalski A (2008) The Gait Deviation Index: a new comprehensive index of gait pathology. Gait Posture 28:351-357. doi:10.1016/j.gaitpost.2008.05.001
  5. Stevens PM, Anderson D (2008) Correction of anteversion in skeletally immature patients. J Pediatr Orthop 28:277-283. doi:10.1097/BPO.0b013e318168d962
  6. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012-1018. doi:10.1302/0301-620X.87B7.15203
  7. Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466:264-272. doi:10.1007/s11999-007-0060-z
  8. Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20-33
  9. Rab GT (1999) The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 19:419-424
  10. Slongo T, Kakaty D, Krause F, Ziebarth K (2010) Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am 92:2898-2908. doi:10.2106/JBJS.I.01385
  11. Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop (2007)
  12. Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T et al (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71:370-375. doi:10.1080/000164700317393367
  13. Castañeda P, Macías C, Rocha A, Harfush A, Cassis N (2009) Functional outcome of stable grade III slipped capital femoral epiphysis treated with in situ pinning. J Pediatr Orthop 29:454-458. doi:10.1097/BPO.0b013e3181aab7c3
  14. Diab M, Daluvoy S, Snyder BD, Kasser JR (2006) Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B 15(2):87-92
  15. Fabricant PD, Fields KG, Taylor SA, Magennis E, Bedi A, Kelly BT (2015) The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery. J Bone Joint Surg Am 97:537-543. doi:10.2106/JBJS.N.00266
  16. El-Mowafi H, El-Adl G, El-Lakkany MR (2005) Extracapsular base of neck osteotomy versus Southwick osteotomy in treatment of moderate to severe chronic slipped capital femoral epiphysis. J Pediatr Orthop 25:171-177
  17. Salvati EA, Robinson JH Jr, O'Down TJ (1980) Southwick osteotomy for severe chronic slipped capital femoral epiphysis: results and complications. J Bone Joint Surg Am 62(4):561-570
  18. Leunig M, Horowitz K, Manner H, Ganz R (2010) In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop Relat Res 468:3160-3167. doi:10.1007/s11999-010-1408-3
  19. Fish JB (1984) Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 66:1153-1168
  20. Gage JR, Sundberg AB, Nolan DR, Sletten RG, Winter RB (1978) Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis. J Bone Joint Surg Am 60:157-165
  21. Heyman CH, Herndon CH (1950) Legg-Perthes disease; A method for the measurement of the roentgenographic result. J Bone Joint Surg Am 32:767-778
  22. Martin PH (1948) Slipped epiphysis in the adolescent hip a reconsideration of open reduction. J Bone Joint Surg Am 30:9-19
  23. Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim Y-J (2009) Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 467:704-716. doi:10.1007/s11999-008-0687-4
  24. Anderson LA, Gililland JM, Pelt CE, Peters CL (2013) Subcapital correction osteotomy for malunited slipped capital femoral epiphysis. J Pediatr Orthop 33:345-352. doi:10.1097/BPO.0b013e31827d7e06
  25. Parsch K, Zehender H, Bühl T, Weller S (1999) Intertrochanteric corrective osteotomy for moderate and severe chronic slipped capital femoral epiphysis. J Pediatr Orthop B 8:223
  26. Stevens PM, Gaffney CJ, Fillerup H (2016) Percutaneous rotational osteotomy of the femur utilizing an intramedullary rod. Strategies Trauma Limb Reconstr 11(2):129-134
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