TO THE EDITOR:

We read with interest “Subclinical Slipped Capital Femoral Epiphysis. Relationship to Osteoarthrosis of the Hip” (79-A: 1489–1497, Oct. 1997), by Goodman et al., which was based on extensive measurement of intact femora from a cohort of skeletons of individuals who were born around the turn of the century. The authors clearly showed that there were more osteophytes in the 8 percent of the specimens that had a so-called subclinical slip deformity than there were in the specimens that did not have this deformity.

To call these specimens osteoarthritic is not consistent with the classic clinical study by Danielsson, who found no arthritic deterioration over ten years in patients who had osteophytes about the hip and a joint space of normal width2. Loss of cartilage, which is necessary to relate osteophytes to osteoarthritis, could not be observed in the study by Goodman et al. because the cartilage was destroyed during the preparation process.

Furthermore, the rates of osteoarthritis reported by Goodman et al. do not match those of clinical studies.The authors reported that 26 percent (seventy-nine) of the 306 age-matched control hips (which did not have a deformity) had grade-2 or 3 osteophytes, which is five times the 5 percent rate of osteoarthritis of the hip that they cited for the current general population. If the ninety-five control hips that had grade-1 osteophytes are also considered to be osteoarthritic, more than half of the control hips had osteoarthritis. Is it possible that the indigent population from that era had such a prevalence of osteoarthritis of the hip?

The anatomical deformity that was described in the gross specimens resembles the deformity of slipped capital femoral epiphysis, but whether this is, in fact, a forme fruste of slipped capital femoral epiphysis is not clear. There are a number …


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