Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation
Background: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater th...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2020-07-01
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| Series: | Journal of Orthopaedic Surgery |
| Online Access: | https://doi.org/10.1177/2309499020937827 |
| _version_ | 1818447280898834432 |
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| author | Youheng Ou Yang Chloe Xiaoyun Chan Gloria Hui Min Cheng Sumanth Kumar Gera Arjandas Mahadev Mohammad Ashik bin Zainuddin |
| author_facet | Youheng Ou Yang Chloe Xiaoyun Chan Gloria Hui Min Cheng Sumanth Kumar Gera Arjandas Mahadev Mohammad Ashik bin Zainuddin |
| author_sort | Youheng Ou Yang |
| collection | DOAJ |
| description | Background: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater than 12–14.5° has been proposed by various authors as a treatment threshold to predict for contralateral hip progression and prophylactic pinning. Methods: A retrospective review of a 10-year series of patients with the diagnosis of SCFE and follow-up of 18 months was conducted. Patients were divided into two groups, those with Isolated Unilateral Slips and those who subsequently underwent Subsequent Contralateral Progression. PSA measurements were performed by two clinicians and assessed for inter-observer reliability. Data collected included age, sex, ethnicity, Loder class, endocrinopathy, renal impairment, radiation exposure, and PSA. Results: There were no significant differences between the distribution of gender, site of slip, age of onset, Loder class, and presence of medical comorbidities between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups ( p > 0.05). The mean PSA value was not significantly higher in the Subsequent Contralateral Progression group (17.9 ± 4.32 (10.5–23.5)) compared to the Isolated Unilateral Slip group (15.8 ± 5.31 (6–26)) ( p = 0.32). The receiver operator coefficient-derived ideal treatment threshold of 16.5° gave a sensitivity of 0.71, specificity of 0.64, and number needed to treat of 3. Conclusion: PSA differences between the Subsequent Contralateral Progression and Isolated Unilateral Slip groups were not statistically significant in this series. All proposed treatment thresholds had poor specificity. Prophylactic pinning should not be based on isolated PSA values. Level of evidence: III. |
| first_indexed | 2024-12-14T20:01:07Z |
| format | Article |
| id | doaj.art-f5ae77c91f794bcb9882d83f14a7a8b7 |
| institution | Directory Open Access Journal |
| issn | 2309-4990 |
| language | English |
| last_indexed | 2024-12-14T20:01:07Z |
| publishDate | 2020-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Orthopaedic Surgery |
| spelling | doaj.art-f5ae77c91f794bcb9882d83f14a7a8b72022-12-21T22:49:10ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902020-07-012810.1177/2309499020937827Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixationYouheng Ou Yang0Chloe Xiaoyun Chan1Gloria Hui Min Cheng2Sumanth Kumar Gera3Arjandas Mahadev4Mohammad Ashik bin Zainuddin5 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, SingaporeBackground: Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial as it balances increased surgical risks against the possibility of protecting a normal hip from initial slip and deformity. A posterior sloping angle (PSA) of greater than 12–14.5° has been proposed by various authors as a treatment threshold to predict for contralateral hip progression and prophylactic pinning. Methods: A retrospective review of a 10-year series of patients with the diagnosis of SCFE and follow-up of 18 months was conducted. Patients were divided into two groups, those with Isolated Unilateral Slips and those who subsequently underwent Subsequent Contralateral Progression. PSA measurements were performed by two clinicians and assessed for inter-observer reliability. Data collected included age, sex, ethnicity, Loder class, endocrinopathy, renal impairment, radiation exposure, and PSA. Results: There were no significant differences between the distribution of gender, site of slip, age of onset, Loder class, and presence of medical comorbidities between the Isolated Unilateral Slip and Subsequent Contralateral Progression groups ( p > 0.05). The mean PSA value was not significantly higher in the Subsequent Contralateral Progression group (17.9 ± 4.32 (10.5–23.5)) compared to the Isolated Unilateral Slip group (15.8 ± 5.31 (6–26)) ( p = 0.32). The receiver operator coefficient-derived ideal treatment threshold of 16.5° gave a sensitivity of 0.71, specificity of 0.64, and number needed to treat of 3. Conclusion: PSA differences between the Subsequent Contralateral Progression and Isolated Unilateral Slip groups were not statistically significant in this series. All proposed treatment thresholds had poor specificity. Prophylactic pinning should not be based on isolated PSA values. Level of evidence: III.https://doi.org/10.1177/2309499020937827 |
| spellingShingle | Youheng Ou Yang Chloe Xiaoyun Chan Gloria Hui Min Cheng Sumanth Kumar Gera Arjandas Mahadev Mohammad Ashik bin Zainuddin Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation Journal of Orthopaedic Surgery |
| title | Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| title_full | Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| title_fullStr | Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| title_full_unstemmed | Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| title_short | Posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| title_sort | posterior sloping angle of the capital femoral physis in slipped capital femoral epiphysis has poor clinical utility and should not guide treatment on prophylactic fixation |
| url | https://doi.org/10.1177/2309499020937827 |
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