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Slipped Capital Femoral Epiphysis

comparative Essay
2105 words
2105 words
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Slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes (LCP) disease are developmental conditions (1, 2) with SCFE being described as a common source of pain and disability, and the most common cause of degenerative hip disease in middle-aged patients (3, 4). Proximal femoral osteotomies following SCFE aim to restore more normal anatomy, improve function and reduce the morbidity and complications of pain, reduced range of movement, early arthritis and leg length discrepancy (3). Up to 50% of involved hips do well with no intervention but these hips are always at risk of developing secondary arthritis and similarly adult hip joints of patients with SCFE are more prone to develop advanced osteoarthritis (5). In general outcomes of osteotomies are associated with more than 50% morbidity (6) and significant complications (7-11).

The management of end stage arthritis in patients with LCP and SCFE is total hip replacement (12). In young patients with end stage arthritis following SCFE and LCP, good prognosis and an implant survival rate of 80% at a follow-up of 10 years has been reported for Charnley prosthesis in the Norwegian arthroplasty register (13). Other studies have reported similar implant survival ranging from 78.1% to 90.7 % (14, 15), which is encouraging but is compounded by problems arising from an active lifestyle such as early failure and revision. The average age in these published reports was 50 years which means that 10 to 20% patients will undergo a revision at 60 years of age and further re-revision surgery there after.

Due to its bone conserving nature, ability to confer joint stability and ease of conversion to a total hip replacement in the event of implant failure, hip resurfacing arthroplasty is gaini...

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...t caution towards generalization of these findings as hip resurfacing is a new procedure and majority of surgeons are in learning phase(27, 28). This is a clinical study therefore lack of radiological follow-up is a limitation in our report. We collect annual hip scores and it has been reported that subjective outcome measures have a high correlation with signs of radiological loosening (29-31). By combining a subjective outcome measure and actual loosening rates, the results from this study will therefore be useful even in the absence of radiological data.

Given the altered and challenging anatomy in these patients and technical difficulties of the procedure plus a high activity level of these patients, we consider our results to be encouraging. We would recommend hip resurfacing as a viable alternative to patients with secondary arthritis following LCP/SCFE.

In this essay, the author

  • Describes the oswestry outcome centre as an independent international register for the collection, analysis, and reporting of outcomes following hip resurfacing arthroplasty.
  • Explains that the data was checked for errors and normality using shapiro-wilk test and analyzed comparatively in terms of demographics, function, complications and implant survival.
  • Compares the mean pre-operative harris hip score between the oa and ls groups.
  • Compares the implant survival in the oa and ls groups by examining the effect of pre-operative diagnosis and age on risk of failure.
  • Explains that the patients in ls group scored 7.5 points higher than those in the oa group and this difference was significant. there was a mild but significant effect of pre-operative score on follow-up scores.
  • Compares the results of engester and boyd et al and concludes that hip resurfacing is an acceptable alternative to total hip replacement for patients with lcp/scfe.
  • Explains that slipped capital femoral epiphysis (scfe) and legg-calve-perthes (lcp) disease are developmental conditions and the most common cause of degenerative hip disease in middle-aged patients.
  • Reports the first study to report outcomes following hip resurfacing for osteoarthritis secondary to lcp and scfe from an independently assessed multi surgeon and multi centre cohort.
  • Opines that the multicentre design and independent assessment of the outcomes helps to reduce the incidence of surgeon bias.
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