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Acetabular Morphology in Slipped Capital Femoral Epiphysis

Sankar, Wudbhav N. MD; Brighton, Brian K. MD, MPH; Kim, Young-Jo MD, PhD; Millis, Michael B. MD

Journal of Pediatric Orthopaedics: April/May 2011 - Volume 31 - Issue 3 - p 254–258
doi: 10.1097/BPO.0b013e31820fcc81

Background Children with unilateral slipped capital femoral epiphysis (SCFE) often appear to have overcoverage of their contralateral (normal) side. This increased coverage can be a contributing factor to femoroacetabular impingement. The purpose of this study was to quantify the coverage of the normal hip in patients with unilateral SCFE and to compare our results to matched controls.

Methods Between 2003 and 2008, we identified 50 patients treated for unilateral, stable SCFE by in-situ screw fixation. Using postoperative anteroposterior and frog radiographs of the pelvis, the lateral center-edge angle (LCEA) and Tönnis angle (TA) were measured on the uninvolved side. Pelvic tilt was evaluated to ensure the quality of the radiographs, and in those patients with appropriate films, the presence or absence of a posterior wall sign and cross-over sign was noted. Results were compared with 50 age and sex-matched controls. Control data was generated from scout views of otherwise healthy patients who underwent an abdominal computed tomography scan to rule out acute appendicitis.

Results The mean LCEA and TA of the contralateral acetabulum were 33 and 5 degrees, respectively (range: 18 to 47; −7 to 13). Seventy-eight percent had a positive cross-over sign and 39% had a posterior wall sign. In comparison, the mean LCEA and TA in our control group were 20 and 8 degrees, respectively (range: 8 to 35; −6 to 23). In this group, 21% had a positive cross-over sign whereas 15% had a positive posterior wall sign. We found a significantly higher LCEA and lower TA in the study population compared with controls (P=1.6E-16, 0.0003), as well as a higher prevalence of retroversion signs (P=5E-7, 0.02).

Conclusions The contralateral acetabulum in patients with treated unilateral SCFE demonstrates significantly more coverage compared with matched controls. In addition, there is a significantly higher prevalence of acetabular retroversion in these patients. Our findings should alert caregivers to the potential of developing femoroacetabular impingement on the contralateral side in patients who have had a unilateral SCFE.

Levels of Evidence III (retrospective case-control).

*Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA

Carolinas Medical Center, Department of Orthopaedics, Charlotte, NC

Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA

No author received support for this study.

This is an IRB approved study.

Reprints: Michael B. Millis, MD, Department of Orthopaedic Surgery, Hunnewell 213, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. e-mail:

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