Treatment Strategies

Treatment for SCFE aims to stabilize the slipped femoral head. Prior to surgery, crutches are recommended to prevent further slippage by reducing weight on the affected hip. For milder slips, fixation of the femoral head with pins or screws is the treatment of choice. In some cases, a single screw through the femoral head and the growth plate into the acetabulum is enough to hold the hip joint in place. 

In other cases, where the slippage is more severe, the resultant hip deformity is corrected via osteotomy (surgical bone cut). For SCFE, the osteotomy may be intra-articular (inside the joint) or extra-articular (outside the joint). The goal of the osteotomy is to realign the joint and restore greater coverage of the femoral head by the acetabulum. 

Examples of osteotomy to correct SCFE
A - Physeal (subcapital) osteotomy
B - Neck osteotomy
C - Base of neck osteotomy
D - Intertrochanteric osteotomy
In each of these examples, the goal is to realign the axis (blue line congruent with red line) and to improve coverage of the femoral head by the acetabulum

 

Femoroacetabular Impingement

One of the complications that may arise from SCFE is femoroacetabular impingement (FAI). FAI occurs when an abnormally shaped hip joint causes the femoral head to rub against the acetabulum, causing pain and limiting motion. FAI in SCFE is caused by an abnormally-shaped femoral head.

Example of bump causing FAI in SCFE. Note also the flattened, non-spherical femoral head

 

Two types of FAI have been identified:

  • Cam type
  • Pincer type

In Cam type FAI the femoral head is not round and cannot rotate properly in the acetabulum. A bump forms on the edge of the femoral head. In Pincer type extra bone extends over the rim of the acetabulum. The femoral head collides with this protrusion during hip movement.

Treatment for FAI is a Safe Surgical Dislocation (SSD) surgery followed by osteotomy. Originally described in Sweden by Dr. Ganz in 2001, this is a complex hip surgery performed routinely at only a few specialized centers in the world. We modified the original procedure and have been performing it for correction of FAI in SCFE patients for years.

In the SSD procedure, the hip is dislocated during surgery allowing visualization of the femoral head. An osteotomy is then performed to reduce the femoral head into the acetabulum. This corrects the impingement and allows greater coverage of the femoral head. Internal screws are applied to hold the arrangement in place.

Before and after safe surgical dislocation and subcapital osteotomy to correct FAI in SCFE. Note the improved acetabular coverage and spherical femoral head after surgery

 

After surgery, physical therapy is crucial to regaining and maximizing hip range of motion in SCFE patients. Physical therapy is also necessary to help these patients improve their gait and walk without limp.

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