Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy

Abstract

Purpose Treatment of slipped capital femoral epiphysis (SCFE), including the modified Dunn procedure, restores anatomy with significant risk for avascular necrosis (AVN), if performed in the setting of moderate to severe, stable SCFE. The Imhauser osteotomy has been shown to be an effective way to correct residual deformity without the risk of AVN. We sought to evaluate the effectiveness and safety of a combined Imhauser osteotomy and osteochondroplasty, performed via a surgical hip dislocation approach for the acute and delayed treatment of stable SCFE. Methods A retrospective review was performed on a series of patients who underwent Imhauser osteotomy and osteochondroplasty via surgical hip dislocation for treatment of chronic, stable SCFE. Patients were divided into acute or delayed treatment groups based on whether osteotomy was performed as the initial slip treatment. Results In total 19 patients (15 male, four female, average age 13.7 years) were reviewed. Six osteotomies were performed acutely in combination with in situ pinning, 13 were delayed at least six months after in situ pinning (average 21.7 months). Two hips had labral tears that required repair. The mean follow-up was 61 months (23 to 120) (delayed) and 53 months (27 to 61) (acute). The average improvement in slip angle was 40.7° (delayed) and 50.2° (acute) (p = 0.0916), final post-operative slip angle averaged 15.8° (delayed) and 17.8° (acute) (p = 0.544). Femoral neck length and greater trochanteric height were similar between both groups. Average alpha angle at final follow-up measured 55.8° (delayed) and 60.8° (acute) (p = 0.542). No cases of AVN were identified. Conclusion Imhauser osteotomy combined with osteochondroplasty via surgical hip dislocation approach is a safe and effective treatment of moderate to severe, stable SCFE performed in both the acute and delayed setting.