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Topic:

Slipped Capital Femoral Epiphysis

Issue:

Hip

Category:

Trauma

Title:

The Effects of Residual Femoral Deformity on Computed Contact Mechanics in Patients Treated With In Situ Fixation for Slipped Capital Femoral Epiphysis

Author:

Aitken, Holly D. PhD; Yen, Yi-Meng MD, PhD; Kiapour, Ata M. PhD; Sailer, Wyatt M.; Holt, Joshua B. MD; Goetz, Jessica E. PhD; Scott, Elizabeth J. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e218-e225, DOI: 10.1097/BPO.0000000000002596

Level Of Evidence:

IV

# of Patients:

19

Study Type:

Retrospective cohort study with computational modeling

Location:

Not specified

Summary:

This study investigates how residual femoral deformity after in situ fixation for slipped capital femoral epiphysis (SCFE) affects intra-articular contact mechanics in the hip joint.

Methods:

Patient-specific hip models were created for 19 SCFE patients. Discrete element analysis was used to compute acetabular and femoral contact stress exposure during a walking gait cycle. SCFE severity was assessed using both the Southwick angle and a novel 3D slip angle.

Exclusions:

None specified.

Results:

Of the SCFE cases, 2/7 mild (Southwick angle ≤30 degrees) had peak cumulative femoral exposures equivalent to severe cases (Southwick angle ≥60 degrees). Severe SCFE cases had higher peak and mean femoral contact stress exposure, as well as lower cumulative femoral contact area, compared to mild SCFE cases. Severe SCFE cases had significantly higher mean femoral contact stress exposure than moderate cases. 3D slip angle demonstrated stronger correlations with contact mechanics than the 2D Southwick angle.

Conclusions:

Greater slip severity adversely impacts femoral contact mechanics in the post-SCFE hip. Contact mechanics metrics correlate more strongly with the 3D slip angle than the Southwick angle, suggesting that 3D measurement may better describe global deformity. Even mild SCFE deformities showed focal regions of high contact stress, indicating that deformity correction might be beneficial even for mild slips to reduce impingement, address incongruities, and prevent osteoarthritis progression.

Relevance:

Limitations:

Perspective:

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