Prognostic factors for long-term outcome of chronic slipped capital femoral epiphysis treated with fixation in situ

PURPOSE: Predictive factors for long-term outcome after in situ fixation for chronic slipped capital femoral epiphysis (SCFE) have so far not been systematically analysed. The aims of this study were to define predictors for long-term outcome and to assess the association between initial grade of slipping and post-slip deformities. METHODS: We studied 51 patients (60 hips) with chronic SCFE treated with in situ fixation. There were 31 males and 20 females with a mean age of 12.9 years. The mean follow-up was 39.0 years (21.1 to 56.8). Post-slip deformity was defined as abnormal alpha (a) angles in anteroposterior (AP) and lateral radiographs; AP angle of 74° and lateral angle of 63° were used as cutoffs between normal and abnormal α-angles. Harris hip score (HHS) less than 85 points was classified as a poor clinical outcome and osteoarthritis was a poor radiographic outcome. RESULTS: The mean slip angle was 31.7° (12° to 77°). The mean AP α-angle was 67.4° (36° to 111°) and the mean lateral α-angle was 57.1° (22° to 104°). Post-slip deformities developed in almost one-third of hips with a mild degree of slipping and in about half the hips with more pronounced degrees of slipping. The long-term outcome was good in 40 hips (67%) and poor in 20 hips. A small AP α-angle was the only independent prognostic factor for a good combined clinical and radiographic outcome. CONCLUSION: Post-slip deformity, defined as an abnormally high AP α-angle, is the most important prognostic factor for poor long-term clinical and radiographic outcome in chronic SCFE treated with in situ fixation.