Page 116 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 7
the deformity completely; however, this procedure can have a high incidence of AVN and chondrolysis [13-18].
We hypothesized that an early ITO performed concurrently with the epiphysiodesis in patients with a moderate or severe slip of the femoral epiphysis would prevent the metaphysis from damaging the anterior part of the acetabulum and, thereby, diminish the incidence of osteoarthritis at a later stage. We also expected that the occurrence of chondrolysis and AVN would be low or absent with this procedure. The aim of the study reported here was to investigate the outcomes of epiphysiodesis combined with an Imhauser ITO performed in one session in moderate and severe slips. The objective of this combined surgical approach is to improve the position of the head in relationship to the acetabulum in order to obtain better prognostic features.
Materials and methods
Subjects
This retrospective study assesses the results of a consecutive series of 28 patients who had moderate to severe SCFE in a total of 32 hips. These patients were treated with a combined epiphysiodesis and Imhauser ITO performed by the same surgeon at the AMC Amsterdam between 1978 and 2003. Patient data are presented in Table 1. A total of 13 patients had bilateral slips versus 15 who had unilateral slips. Of the 13 bilateral patients, four underwent bilateral ITO simultaneously. The other nine had a moderate to severe SCFE on one side only and a mild slip contralaterally and underwent only a K-wire transfixation on the controlateral side. A review of the medical histories of this patient cohort revealed that 13 patients had sustained a trauma. None of the patients had a deviant endocrinological history.
Approval of the medical ethical committee was obtained.
Surgery
Prior to surgery, patients were treated by bed rest on springs and slings for an average of 14 (range 0–28) days. During this time, we designed a time-schedule for operating on the patient. We did not perform gentle reduction on any of our patients. A cannulated screw epiphysiodesis was performed via an open procedure with the use of one 5.0-mm screw. During the same surgical session, following the epiphysiodesis, the Imhauser three-dimensional ITO was performed and fixed with a 90° blade plate [19] (Fig. 2a, b). Thus, the alignment of the head
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