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Chondrolysis, Osteonecrosis, and Slip Severity in Patients with Subsequent Contralateral Slipped Capital Femoral Epiphysis
Yakup Yildirim, MD1; Severino Bautista, MD2; Richard S. Davidson, MD3
1 SOYAK Yenisehir Selale Evleri B1 Daire 9, Umraniye, Istanbul, Turkey. E-mail address: yakup_69@hotmail.com
2 2776 Sagebrush Circle, Apartment 103, Ann Arbor, MI 48103
3 Division of Pediatric Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19082
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Mar 01;90(3):485-492. doi: 10.2106/JBJS.F.01027
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Abstract

Background: Prophylactic pinning of the radiographically and clinically normal contralateral hip in a patient with a unilateral slipped capital femoral epiphysis remains controversial. The purpose of this study was to identify the prevalence of chondrolysis and osteonecrosis and the degree of slip severity in contralateral hips with a subsequent slipped capital femoral epiphysis to determine whether the outcome or complications on the contralateral side were greater than the risks of prophylactic pinning.

Methods: The medical records of the patients operated on between 1993 and 2003 at a single hospital for treatment of a slipped capital femoral epiphysis were retrospectively evaluated. The severity and the chronicity of the slips were graded. Only children who initially had had a unilateral slip and had been followed for a minimum of twenty-four months or until skeletal maturity were included in the analysis for detection of a subsequent contralateral slip. Patients with more than twelve months of follow-up were included in the analysis for detection of osteonecrosis and chondrolysis.

Results: Two hundred and twenty-seven patients had a unilateral slipped capital femoral epiphysis at the time of the primary admission. A subsequent slip developed in the contralateral hip of eighty-two children (36%) within a mean of 6.5 months. Eighteen of the contralateral slips were of moderate or severe severity, with a potential for a poor outcome due to a risk of osteoarthritis in the future. Osteonecrosis or chondrolysis, each an established complication with a poor long-term prognosis, developed in five of the patients with a subsequent contralateral slip.

Conclusions: The high prevalence of a subsequent contralateral slip (36%) and the potential complication (high slip severity) and established complications (osteonecrosis and chondrolysis) related to the contralateral slip indicate that prophylactic pinning of the contralateral hip in a patient with a unilateral slipped capital femoral epiphysis is safer than and preferable to observation and symptomatic treatment.

Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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