Minimal Out-Toeing and Good Hip Scores of Severe SCFE Patients Treated With Modified Dunn Procedure and Contralateral Prophylactic Pinning at Minimal 5-year Follow Up

Overview

Journal J Pediatr Orthop

Specialty Pediatrics

Date 2022 Mar 7

PMID 35250015

Authors

Till D Lerch

Adam Boschung

Christiane Leibold

Roger Kalla

Hassen Kerkeni

Heiner Baur

Patric Eichelberger

Simon D Steppacher

Emanuel F Liechti

Klaus A Siebenrock

Moritz Tannast

Kai Ziebarth

Affiliations

Soon will be listed here.

Abstract

Background: Slipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the modified Dunn procedure have out-toeing at follow up.Therefore, we used instrumented gait analysis and questioned (1) do severe SCFE patients treated with a modified Dunn procedure have symmetrical foot progression angle (FPA) compared with contralateral side and compared with asymptomatic volunteers (2) what is the prevalence of out-toeing gait and what are the outcome socres at follow up.

Methods: Gait analysis of 22 patients (22 hips) treated with an unilateral modified Dunn procedure for severe SCFE (slip angle >60 degrees, 2002 to 2011) was retrospectively evaluated. Of 38 patients with minimal 5-year follow up, 2 hips (4%) had avascular necrosis of the femoral head and were excluded for gait analysis. Twenty-two patients were available for gait analysis at follow up (mean follow up of 9±2 y). Mean age at follow up was 22±3 years. Mean preoperative slip angle was 64±8 degrees (33% unstable slips) and decreased postoperatively (slip angle of 8±4 degrees). Gait analysis was performed with computer-based instrumented walkway system (GAITRite) to measure FPA with embedded pressure sensors. Patients were compared with control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29±6 y).

Results: (1) Mean FPA of SCFE patients (3.6±6.4 degrees) at follow up was not significantly different compared with their contralateral side (5.6±5.5 degrees) and compared with FPA of controls (4.0±4.5 degrees). (2) Of the 22 SCFE patients, most of them (19 hips, 86%) had normal FPA (-5 to 15 degrees), 2 patients had in-toeing (FPA<-5 degrees) and 1 had out-toeing (FPA >15 degrees) and was not significantly different compared with control group. (3) Mean modified Harris hip score (mHHS) was 93±11 points, mean Hip Disability and Osteoarthritis Outcome Score (HOOS) score was 91±10 points. Three patients (14%) had mHHS <80 points and walked with normal FPA. The 2 patients with in-toeing and one patient with out-toeing had mHHS >95 points.

Conclusions: Patients with severe SCFE treated with modified Dunn procedure had mostly symmetrical FPA and good hip scores at long term follow up. This is in contrast to previous studies. Although 1 patient had out-toeing and 2 patients had in-toeing at follow up, they had good hip scores.

Level Of Evidence: Level III-retrospective comparative study.

Citing Articles

Low Rate of AVN and Complications in Unstable SCFE With Epiphyseal-metaphyseal Discontinuity After Treatment With a Modified Dunn Procedure.

Ziebarth K, Lerch T, Kaim T, Schwab J, Steppacher S, Tannast M Clin Orthop Relat Res. 2024; 482(9):1598-1610.

PMID: 39226523 PMC: 11343521. DOI: 10.1097/CORR.0000000000003123.

Assessment of femoral retroversion on preoperative hip magnetic resonance imaging in patients with slipped capital femoral epiphysis: Theoretical implications for hip impingement risk estimation.

Lerch T, Kaim T, Hanke M, Schmaranzer F, Steppacher S, Busch J J Child Orthop. 2023; 17(2):116-125.

PMID: 37034201 PMC: 10080244. DOI: 10.1177/18632521221149044.

References

Abraham E, Gonzalez M, Pratap S, Amirouche F, Atluri P, Simon P . Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop. 2007; 27(7):788-95. DOI: 10.1097/BPO.0b013e3181558c94. View

Castaneda P, Ponce C, Villareal G, Vidal C . The natural history of osteoarthritis after a slipped capital femoral epiphysis/the pistol grip deformity. J Pediatr Orthop. 2013; 33 Suppl 1:S76-82. DOI: 10.1097/BPO.0b013e318277174c. View

Song K, Halliday S, Reilly C, Keezel W . Gait abnormalities following slipped capital femoral epiphysis. J Pediatr Orthop. 2004; 24(2):148-55. DOI: 10.1097/00004694-200403000-00003. View

Cibulka M, Winters K, Kampwerth T, McAfee B, Payne L, Roeckenhaus T . PREDICTING FOOT PROGRESSION ANGLE DURING GAIT USING TWO CLINICAL MEASURES IN HEALTHY ADULTS, A PRELIMINARY STUDY. Int J Sports Phys Ther. 2016; 11(3):400-8. PMC: 4886808. View

Presedo A, Simon A, Mallet C, Ilharreborde B, Mazda K, Pennecot G . Correlation between transverse plan kinematics and foot progression angle in children with spastic diplegia. J Pediatr Orthop B. 2016; 26(3):211-216. DOI: 10.1097/BPB.0000000000000416. View

Rab G . The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999; 19(4):419-24. DOI: 10.1097/00004694-199907000-00001. View

Lerch T, Todorski I, Steppacher S, Schmaranzer F, Werlen S, Siebenrock K . Prevalence of Femoral and Acetabular Version Abnormalities in Patients With Symptomatic Hip Disease: A Controlled Study of 538 Hips. Am J Sports Med. 2017; 46(1):122-134. DOI: 10.1177/0363546517726983. View

Schwartz M, Trost J, Wervey R . Measurement and management of errors in quantitative gait data. Gait Posture. 2004; 20(2):196-203. DOI: 10.1016/j.gaitpost.2003.09.011. View

Kamegaya M, Saisu T, Nakamura J, Murakami R, Segawa Y, Wakou M . Drehmann sign and femoro-acetabular impingement in SCFE. J Pediatr Orthop. 2011; 31(8):853-7. DOI: 10.1097/BPO.0b013e31822ed320. View

10.

Ziebarth K, Milosevic M, Lerch T, Steppacher S, Slongo T, Siebenrock K . High Survivorship and Little Osteoarthritis at 10-year Followup in SCFE Patients Treated With a Modified Dunn Procedure. Clin Orthop Relat Res. 2017; 475(4):1212-1228. PMC: 5339158. DOI: 10.1007/s11999-017-5252-6. View

11.

Diab M, Daluvoy S, Snyder B, Kasser J . Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B. 2006; 15(2):87-92. DOI: 10.1097/01.bpb.0000186646.84321.2f. View

12.

Bruderer-Hofstetter M, Fenner V, Payne E, Zdenek K, Klima H, Wegener R . Gait deviations and compensations in pediatric patients with increased femoral torsion. J Orthop Res. 2014; 33(2):155-62. DOI: 10.1002/jor.22746. View

13.

Seber S, Hazer B, Kose N, Gokturk E, Gunal I, Turgut A . Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults. Arch Orthop Trauma Surg. 2000; 120(5-6):255-8. DOI: 10.1007/s004020050459. View

14.

Ho C, Lin C, Chou Y, Su F, Lin S . Foot progression angle and ankle joint complex in preschool children. Clin Biomech (Bristol). 2000; 15(4):271-7. DOI: 10.1016/s0268-0033(99)00068-6. View

15.

Novais E, Hill M, Carry P, Heare T, Sink E . Modified Dunn Procedure is Superior to In Situ Pinning for Short-term Clinical and Radiographic Improvement in Severe Stable SCFE. Clin Orthop Relat Res. 2014; 473(6):2108-17. PMC: 4419009. DOI: 10.1007/s11999-014-4100-1. View

16.

Yoo W, Choi I, Cho T, Chung C, Park M, Lee D . Out-toeing and in-toeing in patients with Perthes disease: role of the femoral hump. J Pediatr Orthop. 2008; 28(7):717-22. DOI: 10.1097/BPO.0b013e318186c4be. View

17.

Ganz R, Huff T, Leunig M . Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009; 58:241-55. View

18.

Lerch T, Eichelberger P, Baur H, Schmaranzer F, Liechti E, Schwab J . Prevalence and diagnostic accuracy of in-toeing and out-toeing of the foot for patients with abnormal femoral torsion and femoroacetabular impingement: implications for hip arthroscopy and femoral derotation osteotomy. Bone Joint J. 2019; 101-B(10):1218-1229. DOI: 10.1302/0301-620X.101B10.BJJ-2019-0248.R1. View

19.

Lai Y, Lin H, Pan H, Chang W, Hsu C, Renn J . Impact of foot progression angle on the distribution of plantar pressure in normal children. Clin Biomech (Bristol). 2013; 29(2):196-200. DOI: 10.1016/j.clinbiomech.2013.11.012. View

20.

Sangeux M, Passmore E, Gomez G, Balakumar J, Graham H . Slipped capital femoral epiphysis, fixation by single screw in situ: A kinematic and radiographic study. Clin Biomech (Bristol). 2014; 29(5):523-30. DOI: 10.1016/j.clinbiomech.2014.03.012. View