Retrospective Analysis of the Clinical and Radiological Outcomes Following Modified Dunn Osteotomy in Patients with Stable, Moderate-to-severe Chronic Slipped Capital Femoral Epiphysis

Abstract

Objective The management of slipped capital femoral epiphysis (SCFE) has been completely transformed by modified Dunn osteotomy, a subcapital realignment osteotomy achieved through a safe surgical dislocation technique originally described by Ganz. The purpose of this study was to evaluate the clinical and radiological outcomes of patients with moderate to severe SCFE after modified Dunn osteotomy.

Methods A total of 15 patients (16 hips, with one bilateral case; 12 males, 3 females) aged from 10.2 to 17-years-old (mean: 14.3) with stable, moderate to severe, chronic SCFE (moderate: = 6; severe = 10) underwent modified Dunn osteotomy as treatment. The hip joint range of motion (ROM), Harris (HHS), and Merle d'Aubigné (MdA) hip scores were used for clinical assessments. They were assessed radiographically using the Southwick and Alpha angles.

Results At the most recent follow-up (mean 8.6 years; 3.1–14), the mean hip joint ROM, the mean HHS (preoperative: 69.20 ± 5.94; postoperative: 86 ± 7.37; p < 0.00001), and the mean MdA score (preoperative: 12.47 ± 1.13; postoperative: 14.27 ± 1.83; p < 0.00001) all showed statistically significant clinical improvements The radiological results demonstrated improvements in the mean Southwick angle (preoperative: 56.60 ± 12.89°; postoperative: 16.40 ± 4.69°; p < 0.00001) and Alpha angle (preoperative: 101.87 ± 12.88°; postoperative: 29.33 ± 7.29°; p < 0.00001). There were two significant postoperative complications identified: femoral head avascular necrosis (AVN) and deep infection.

Conclusion According to the study's findings, the modified Dunn osteotomy is a safe, efficient treatment option for stable moderate-to-severe chronic SCFE with a manageable risk of complications.

Keywords

hip - osteonecrosis - osteotomy - slipped capital femoral epiphysis

Work carried out at the Department of Orthopedics and Trauma, GMERS Medical College and General Hospital, Himmatnagar, Sabarkantha, Gujarat, India.

Publikationsverlauf

Eingereicht: 12. März 2024

Angenommen: 21. Mai 2024

Artikel online veröffentlicht:
21. Dezember 2024

• Referências

• 1 Loder RT, Skopelja EN. The epidemiology and demographics of slipped capital femoral epiphysis. ISRN Orthop 2011; 2011: 486512
• 2 Fahey JJ, O'Brien ET. Acute slipped capital femoral epiphysis: Review of the literature and report of ten cases. J Bone Joint Surg Am 1965; 47: 1105-1127
• 3 Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am 1993; 75 (08) 1134-1140
• 4 Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967; 49 (05) 807-835
• 5 Galletta C, Aprato A, Giachino M. et al. Modified Dunn procedure versus percutaneous pinning in moderate/severe stable slipped capital femoral epiphyses. Hip Int 2022; 32 (06) 813-819
• 6 Jones CE, Cooper AP, Doucette J. et al. Relationships Between Severity of Deformity and Impingement in Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2017; 37 (04) 272-278
• 7 Dunn DM, Angel JC. Replacement of the femoral head by open operation in severe adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg Br 1978; 60-B [phone]
• 8 Fish JB. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. J Bone Joint Surg Am 1984; 66 (08) 1153-1168
• 9 Abraham E, Garst J, Barmada R. Treatment of moderate to severe slipped capital femoral epiphysis with extracapsular base-of-neck osteotomy. J Pediatr Orthop 1993; 13 (03) 294-302
• 10 Kramer WG, Craig WA, Noel S. Compensating osteotomy at the base of the femoral neck for slipped capital femoral epiphysis. J Bone Joint Surg Am 1976; 58 (06) 796-800
• 11 Imhäuser G. [Late results of Imhäuser's osteotomy for slipped capital femoral epiphysis (author's transl)]. Z Orthop Ihre Grenzgeb 1977; 115 (05) 716-725
• 12 Ganz R, Huff TW, Leunig M. Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect 2009; 58: 241-255
• 13 Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 2008; 57: 499-507
• 14 Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51 (04) 737-755
• 15 D'Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954; 36-A [phone]
• 16 Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84 (04) 556-560
• 17 Mathew SE, Larson AN. Natural History of Slipped Capital Femoral Epiphysis. J Pediatr Orthop 2019; 39 (6, Supplement 1 Suppl 1) S23-S27
• 18 Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 1999; 19 (04) 419-424
• 19 Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol 2007; 19 (04) 389-410
• 20 Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res 2009; 467 (03) 704-716
• 21 Madan SS, Cooper AP, Davies AG, Fernandes JA. The treatment of severe slipped capital femoral epiphysis via the Ganz surgical dislocation and anatomical reduction: a prospective study. Bone Joint J 2013; 95-B [phone]
• 22 Upasani VV, Matheney TH, Spencer SA, Kim YJ, Millis MB, Kasser JR. Complications after modified Dunn osteotomy for the treatment of adolescent slipped capital femoral epiphysis. J Pediatr Orthop 2014; 34 (07) 661-667
• 23 Abdelazeem AH, Beder FK, Abdel Karim MM, Abdelazeem H, Abdel-Ghani H. The anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis by modified Dunn subcapital osteotomy using the Ganz approach: functional and radiological outcomes. Bone Joint J 2016; 98-B [phone]
• 24 Elmarghany M, Abd El-Ghaffar TM, Seddik M. et al. Surgical hip dislocation in treatment of slipped capital femoral epiphysis. SICOT J 2017; 3: 10
• 25 Lerch TD, Vuilleumier S, Schmaranzer F. et al. Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up. Bone Joint J 2019; 101-B [phone]
• 26 Ebert N, Rupprecht M, Stuecker R. et al. Outcome of the modified Dunn procedure in severe chronic or acute on chronic slipped capital femoral epiphysis. J Orthop Surg Res 2019; 14 (01) 349
• 27 Zuo B, Zhu JF, Wang XY, Wang CL, Ma F, Chen XD. Outcome of the modified Dunn procedure in severe slipped capital femoral epiphysis. J Orthop Surg Res 2020; 15 (01) 506
• 28 Agashe MV, Pinto DA, Vaidya S. Modified Dunn Osteotomy for Moderate and Severe Slipped Capital Femoral Epiphysis - A retrospective study of thirty hips. Indian J Orthop 2020; 55 (01) 100-108
• 29 Gorgolini G, Caterini A, Efremov K. et al. Surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz: a systematic review. BMC Musculoskelet Disord 2022; 22 (Suppl. 02) 1064