Slipped Capital Femoral Epiphysis: Surgical Techniques, Complications, Special Topics

Abstract

Several types of implants have been used for the treatment of SCFE. Apart from the non specific implants, such as pins or cannulated screws, other specific implants for SCFE have been manufactured. Most of these specific implants (telescopic screw, pinscrew, Hansson screw etc) efficiently prevent slip progression while preserving bone growth. Thus head and neck growth and remodeling is maintained, resulting in a lower slip angle and increased head neck offset. Femoroacetabular impingement is the most frequent complication of SCFE, that is seen even in mild slips. Its impact on the acetabulum depends on the severity but also on the chronicity of the slip. Avascular necrosis of the femoral head is the most devastating complication of SCFE leading to early total hip replacement. A rare but catastrophic complication is chondrolysis, causing a substantial articular cartilage loss. Other complications are implant related, including implant failure such as bending, migration and loosening. Prophylactic stabilization of the asymptomatic contralateral hip remains controversial. SCFE still remains a disease characterized by a high incidence of delayed diagnosis and many studies have dealt with the incidence of silent, asymptomatic and subclinical SCFE. There is still no consensus about the removal of the implants in the absence of implant-related symptoms. Lately, there is increasing interest on the role of arthroscopically assisted osteochondroplasty for the prevention and early treatment of FAI.