Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis

Abstract

Stable slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder managed with in situ fixation of the proximal femoral epiphysis, otherwise known as ‘pinning the hip’. The objective of this study was to characterize how the choice of implant for in situ fixation of stable SCFE has changed over time. A systematic review of publications concerning in situ fixation of stable SCFE from January 1993 to November 2021 was conducted. The change in the type, diameter, and number of implants used in publications over time and the age of their respective patient cohorts was evaluated. A total of 207 articles met inclusion criteria. There was an increase in publications using cannulated screws over time (P = 0.0113). As the yearly percentage of publications using threadless non-cannulated implants decreased (P = 0.0309), the percentage using cannulated screws increased (P = 0.0047). Single-implant fixation also increased (P = 0.0409). While there was no difference in the rate of increase of implants < 7 mm or ≥ 7 mm in diameter (P = 0.299), patients with larger-diameter implants were, on average, older than patients with smaller-diameter implants (P = 0.0462). In general, the age of patients undergoing in situ fixation of stable SCFE has not changed (P = 0.595). Irrespective of patient-specific considerations, single cannulated screws have become the implant of choice for in situ fixation of stable SCFE. There has not been a consensus on the optimal implant diameter; instead, patient-specific considerations are of paramount importance in this decision.