The Swedish experience of capital realignment surgery for slipped capital femoral epiphysis: results from a nationwide retrospective cohort of 28 patients
DOI:
https://doi.org/10.2340/17453674.2026.46429Keywords:
Alpha angle, Capital Realignment, Hip, Modified Dunn, Osteonecrosis, Paediatric orthopaedicsAbstract
Background and purpose: Optimal treatment for slipped capital femoral epiphysis (SCFE) has been controversial for decades. Capital realignment surgery (predominant technique: modified Dunn) is a technique to restore anatomy, but it is associated with varying risks of avascular necrosis (AVN) of the femoral head. The aim of our study was to describe outcomes following capital realignment for severe SCFE in a nationwide cohort.
Methods: A longitudinal, nationwide, retrospective cohort study of SCFE patients treated with capital realignment between 2009 and 2021 was conducted, with radiographic and clinical follow-up 2–15 years after surgery. Primary radiographic outcome was AVN. Clinical outcomes were assessed using patient-reported outcome measures (the Copenhagen Hip and Groin Outcome Score [HAGOS] and the 12-item International Hip Outcome Tool [iHOT12]).
Results: 28 patients were included but 1 patient declined radiographic follow-up. 6/27 (22%, 95% confidence interval [CI] 11–41), developed AVN: 2/19 patients with stable SCFE and 4/8 patients with unstable SCFE. None of the 8 cases in which epiphyseal perfusion was monitored intraoperatively developed AVN. The median total HAGOS and iHOT12 scores were 77 (CI 56–94) and 76 (CI 72–88), respectively. When capital realignment was performed as primary treatment (< 1 month from diagnosis), the corresponding scores were 91 (CI 70–98) and 88 (CI 73–98).
Conclusion: The overall AVN rate was 22%. Our findings suggest that capital realignment should be reserved for stable SCFE and performed as primary treatment, with intraoperative epiphyseal perfusion monitoring.
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References
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