Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable:A systematic review

BACKGROUND Slipped capital femoral epiphysis (SCFE) occurs in adolescents and has an incidence of around 10 per 100000 children. Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population. Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient, an underlying endocrine disorder, growth hormone use and a higher radiographic posterior sloping angle. However, there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient. AIM To investigate the risk rate of contralateral SCFE and assess the (dis)advantages of prophylactic fixation of the contralateral hip. METHODS A systematic literature search was performed in the Embase, Medline, Web of Science Core Collection and Cochrane databases. Search terms included ‘slipped capital femoral epiphysis,’ ‘fixation,’ ‘contralateral,’ and derivatives. The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing. Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side, or about the rates of contralateral slips and complications thereof. The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria. RESULTS Of 293 identified unique publications, we included 26 studies with a total of 12897 patients. 1762 patients (14%) developed a subsequent symptomatic contralateral slip. In addition, 38% of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms. The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an (asymptomatic) slip, thus reducing the increased risk of avascular necrosis (AVN), cam morphology and osteoarthritis. Disadvantages include an increased risk of infection, AVN, peri-implant fractures, loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance. These risks, however, appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE. CONCLUSION The advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages. The final decision for treatment remains to be patient-tailored

Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable:A systematic review

BACKGROUNDSlipped capital femoral epiphysis (SCFE) occurs in adolescents and has an incidence of around 10 per 100000 children. Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population. Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient, an underlying endocrine disorder, growth hormone use and a higher radiographic posterior sloping angle. However, there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient.AIMTo investigate the risk rate of contralateral SCFE and assess the (dis)advantages of prophylactic fixation of the contralateral hip.METHODSA systematic literature search was performed in the Embase, Medline, Web of Science Core Collection and Cochrane databases. Search terms included ‘slipped capital femoral epiphysis,’ ‘fixation,’ ‘contralateral,’ and derivatives. The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing. Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side, or about the rates of contralateral slips and complications thereof. The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria.RESULTSOf 293 identified unique publications, we included 26 studies with a total of 12897 patients. 1762 patients (14%) developed a subsequent symptomatic contralateral slip. In addition, 38% of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms. The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an (asymptomatic) slip, thus reducing the increased risk of avascular necrosis (AVN), cam morphology and osteoarthritis. Disadvantages include an increased risk of infection, AVN, peri-implant fractures, loss of fixation as well as migration of hardware and morphologic changes as a consequence of growth guidance. These risks, however, appeared to only occur incidentally and were usually mild compared to the risks involved with an actual SCFE.CONCLUSIONThe advantages of prophylactic pinning of the unaffected side in otherwise healthy patients with unilateral SCFE seem to outweigh the disadvantages. The final decision for treatment remains to be patient-tailored

Partial resurfacing with varus osteotomy for an osteochondral defect of the femoral head

Osteochondral defects of the femoral head represent a major challenge and various modern treatment options exist. We report a 16-year-old male with a large (3 x 3cm) osteochondral defect of the femoral head that was treated with a partial resurfacing prosthesis combined with a high varus osteotomy, performed by surgical dislocation of the hip. Two years after surgery the patient was progressing well without complications. (Hip International 2009; 19: 67-70

Is the Long-term Outcome of Cemented THA Jeopardized by Patients Being Overweight?

Although the effect of being overweight on the long- and short-term outcome of THA remains unclear, the majority of orthopaedic surgeons believe being overweight negatively influences the longevity of a hip implant. We asked whether complications and long-term survival of cemented THA differed in overweight patients (body mass index [BMI] > 25 kg/m2) and obese patients (BMI > 30 kg/m2) compared with normal-weight patients (BMI < 25 kg/m2). We retrospectively analyzed 411 consecutive patients (489 THAs) treated with cemented THA between 1974 and 1993. Except for cardiovascular comorbidity, we observed no differences in demographics among these weight groups. We found no differences in the number of intraoperative or postoperative complications. The survival rates for the three BMI groups were similar. The 10-year survival for any revision was 94.9% (95% confidence interval, 91.6%–98.2%), 90.4% (95% confidence interval, 85.6%–95.2%), and 91% (95% confidence interval, 81.2%–100%) for normal-weight, overweight, and obese patients, respectively. Cox regression analysis showed BMI and weight had no major influence on survival rates. The differences in mean Harris hip score at final followup were 4.8 between normal-weight and overweight patients and 7.1 between normal-weight and obese patients. Being overweight and obesity had no influence on perioperative complication rates in this cohort and did not negatively influence the long-term survival of cemented THA