Complications

Chondrolysis

 

Definition

- loss of 50% joint space or < 3mm joint space

 

Epidemiology

- female 2:1

- 10-20% of SUFE 

 

Causes

 

1.  Head penetration

- use only 1 screw

 

2.  Immunologically mediated global loss of articular cartilage

- can occur in no treatment of SUFE

 

Clinical

- painful and reduced ROM

- flexion / adduction contracture

 

Management

- rest / ROM exercises / NSAID

- ilizarov distraction - unknown long term results

- 50% resolve

- very difficult problem - may need THR / arthrodesis

 

AVN

 

Incidence

- 5 % in chronic slips

- 20% in acute on chronic slip  

- up to 50% in unstable slip

- much worse if MUA

 

Risk factors

 

1. Reduction 

2. Posterosuperior quadrant pin placement

3. > 1 pin 

4. Severity slip 

- ? results skewed by increased MUA in this group

5. Unstable SUFE - unable to weight bear / Loder

 

Salvage options

 

1.  Hip distractor

2.  Valgus osteotomy

- redirect WB area away from AVN

 

Subtrochanteric Fracture

 

Cause

- too low screw entry

- multiple drill holes to get correct entry

 

Management

- > 15 reconstruction nail

- < 15 DHS or DCS

 

Further physeal slipping

 

Cause

- poor screw positioning

- young patient

- failure physeal fusion

- removal of screw before fusion

 

Cam FAI

Principle

Epiphysis heals in a posterior and inferior position = abnormal contact of relatively anterior neck on the acetabulum

 

Incidence

- common with moderate - severe nonrealigned

 

Options

1) Joint Preserving

 - Arthroscopic - Osteochondroplasty

 - Open - Osteochondroplasty with open surgical dislocation +/- Dunn Osteotomy at the level of the femoral neck  

 

2) Joint Sacrificing - THR for advanced cases

 

OA

 

Natural History

 

Not completely known

- still occurs in uncomplicated treatment SUFE 

- even unknown if pistol grip deformity is from SUFE

 

Schlenzka et al, Bone Joint J. 2023

- retrospective review of 172 hips post insitu fixation

- 41% of hips end in THA at 50 year follow up

 

Carney et al JBJS Am 1991

- 155 hips with 40 year follow up

- 24% THA

 

Wensaas et al J Child Orthop 2011

- 76 hips with 38 year follow up

- 21% THA