Femoral and acetabular re-alignment in slipped capital femoral epiphysis

NEW PATHOPHYSIOLOGICAL INSIGHTS: Based on improved knowledge of the vascular supply of the proximal femur, a safe surgical dislocation of the hip joint was established allowing direct insights to the pathomorphological malfunctioning of the joint. One insight was that slipped capital femoral epiphysis (SCFE) impingement leads to substantial damage of the chondrolabral rim area, even in the presence of minor slips. A further surgical development was the extended retinacular flap allowing for correction of the deformity with calculable risk for iatrogenic necrosis. CONSECUTIVE SURGICAL CONCEPT: In 20 years of experience, a treatment concept for SCFE could be established which replaces classic pinning in situ and indirect correction of the deformity with subcapital re-alignment when the physis is still open, with true femoral neck osteotomy for hips with closed physis. Pinning in situ still has a place in minor slips but should be combined with open or arthroscopic recreation of an anterior metaphyseal waisting. UNEXPECTED COMPLICATION: Loss of joint stability is a rare complication of anatomic re-alignment. It can be disease-related when the impingement has induced severe destruction of acetabular cartilage. It can be related to the surgical procedure, especially when the neck was excessively shortened and refixation of the trochanter was not advanced. Finally, in cases with severe and long-lasting deformity, the acetabulum may undergo adaptive flattening, being the cause of joint destabilisation with the correction of the deformity. Advancement of the greater trochanter and/or peri-acetabular osteotomy may be discussed to restabilise the joint.