Key result
Surgical hip dislocation demonstrated improved correction of the alpha angle (mean 41.45°) compared to arthroscopic (32.14°) and open osteotomy (6.0°) treatments, albeit at higher complication and revision rates.
Why the study?
What are the comparative efficacies and complication rates of different surgical treatments for femoroacetabular impingement following slipped capital femoral epiphysis?
Systematic Review (n=261)
What are the comparative efficacies and complication rates of different surgical treatments for femoroacetabular impingement following slipped capital femoral epiphysis?
Absolute Event Rate: 41.45% vs 32.14%
p-value: p=<0.05
In SCFE-related FAI, surgical hip dislocation provides the greatest correction of the alpha angle but is associated with higher complication rates compared to arthroscopic and open osteotomy treatments.
Greater correction with surgical hip dislocation warrants caution due to higher complications in SCFE-related FAI; extends comparative data but highlights need for RCTs.
Objectives The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies. Results Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively. Conclusion In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety. Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1.
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Oduwole et al. (2017) conducted a systematic review in Femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE) (n=261). Surgical hip dislocation vs. Arthroscopic osteochondroplasty and open osteotomy was evaluated on Mean alpha angle correction (p=<0.05). Surgical hip dislocation demonstrated improved correction of the alpha angle (mean 41.45°) compared to arthroscopic (32.14°) and open osteotomy (6.0°) treatments, albeit at higher complication and revision rates.
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