Clinical Evaluation of outcomes in treating Controversial problems in Slipped Capital Femoral Epiphysis using new methods

SCFE is a challenging condition which can lead to long term problems in the hip. There are increasing number of complications when severe grade or unstable SCFE is treated with in situ pinning. In publication one, I propose a classification which helps in decision making: whether to treat this with percutaneous pinning or open surgery. I allude to the current classifications, and its shortcomings and show that this is a workable classification to assess the magnitude and direction of slip. In publication two, I describe surgical dislocation approach to correct deformity of SCFE and recreate anatomy of the hip. I evaluate the results and outcomes. I conclude that the AVN risk is similar to other open reduction procedures reported in literature. In publication three, I describe the avascular necrosis issue with unstable SCFE. I then show how I evolved a technique of salvaging these hips by hinged distraction. I found that distracting the hip, off loads it and prevents collapse and allows the head to consolidate. This technique doesn’t work after collapse of the femoral head. In publication 4, I describe arthroscopic technique of minimising Femoro-Acetabular Impingement (FAI) and treating its ill effects on joint cartilage. I assess the outcome of this surgery and show that early arthroscopy after pinning in situ is better, to minimise the damaging effect of impingement on the hip. In publication 5, I describe the open subcapital neck osteotomy and alignment procedure for severe SCFE and describe its outcomes. I show that surgical dislocation technique is safe and effective in these cases. Our numbers were small, so we perhaps didn’t encounter AVN but review of the literature does suggest that this risk can be significant. In publication 6, I compare the arthroscopic correction of severe SCFE deformity to open subcapital osteotomy in healed SCFE and describe the pros and cons of each treatment and its limitations. Both these cohort of patients were satisfied and none of the arthroscopic group of patients have ever needed a secondary proximal femoral osteotomy. The freedom of movement they gained by intra-articular correction of FAI suggests that this may be a major issue in severe SCFE rather than loss of internal rotation.