Cutting-Edge Pediatric Orthopaedics 2017: A Global Perspective
Drs Wright and Ramachandran have written a paper summarizing the European perspective on slipped capital femoral epiphysis (SCFE). In their review of the varied approaches to treatment of this acquired hip problem of adolescence, they document a number of important facts concerning this condition based on literature review and society questionnaires. They clearly differentiate the risk of avascular necrosis between stable and unstable hips.
In unstable SCFE, avascular necrosis may be related to (1) timing of treatment, (2) intracapsular decompression, (3) early osteotomy, and (4) degree of displacement. It is difficult from the literature to establish absolute recommendations for treatment. Long-term studies by BOSS, BSCOS, and EPOS will be required in order to differentiate the relationship of early treatments to the onset of subsequent degenerative arthritis.
Although it is clear that severity of deformity is related to rapidity of onset of degenerative arthritis, it is not established to what degree deformity altering operations have a predictable effect in decreasing the risk of degenerative joint disease when applied broadly. The orthopedic community in all countries will benefit from large studies characterizing the effect of deformity altering procedures on hip longevity. It is quite clear that stabilization of the proximal femoral epiphysis with single screw treatment in stable SCFE is the treatment of choice in mild and moderate cases.
As one looks for firm data on which to base decisions about treatment of severe stable SCFE and unstable SCFE, one finds the literature lacking but improving. We await a time of certainty as we continue to treat children with SCFE in the best and safest way possible.
James R. Kasser, MD
Harvard Medical School, Boston Children’s Hospital, Boston, MA