Epiphyseolysis capitis femoris (ECF)

Zusammenfassung

Die Epiphyseolysis capitis femoris (ECF) ist die häufigste Hüftgelenkserkrankung des Jugendlichen bei steigender Tendenz. Grund dafür ist der ebenfalls steigende Body Mass Index in dieser Altersgruppe. Um Komplikationen und Folgeschäden zu minimieren, ist eine frühzeitige Diagnostik und Therapie erforderlich, um ein persistierendes Cam-Impingement mit späterer Arthroseentwicklung zu vermeiden. Es gibt sowohl offene als auch arthroskopische Operationsverfahren um eine Rekonturierung des Schenkelhalses nach Abschluss des physiologischen Remodelings zu erzielen. Zu klären bleibt weiterhin die Frage nach dem optimalen Operationsverfahren mit den bestehen Langzeitergebnissen bei Epiphyseolysis capitis femoris.

Die Epiphyseolysis capitis femoris (ECF) ist die häufigste Hüftgelenkserkrankung des Jugendlichen bei steigender Tendenz. Um Komplikationen und Folgeschäden zu minimieren, ist eine frühzeitige Diagnostik und Therapie erforderlich, um ein persistierendes Cam-Impingement mit späterer Arthroseentwicklung zu vermeiden.

Abstract

Slipped capital femoral epiphysis is the most common hip disease during infancy and adolescence. The incidence of this disease increases continuously. The reason is the likewise increasing body mass index of these age groups. Early diagnostic and treatment are necessary to avoid complications and consequential damages. Primary aims of the treatment are to avoid a further slip of the epiphysis and to reduce the resulting cam-deformity by reposition or osteotomy. After the end of physiological remodelling the rest of cam-deformity should be treated before an early osteoarthritis after slipped capital femoral epiphysis can be developed. There are open as well as arthroscopic surgical procedures for recontouring the femoral neck. The question at hand is to find out which surgical procedure will lead to an improvement of the long term results of slipped capital femoral epiphysis.

Schlüsselwörter

Epiphyseolysis capitis femoris - Imhäuser-Osteotomie - Cam-Deformität - subkapitale Osteotomie - avaskuläre Nekrose

Key words

slipped capital epiphysis - cam impingement - subcapital osteotomy - intertrochanteric osteotomy - avascular necrosis

• Literatur

• 1 Lehmann CL, Arons RR, Loder RT. et al. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop 2006; 26: 286-290 doi:10.5402/2011/486512
• 2 Murray AW, Wilson NI. Changing incidence of slipped capital femoral epiphysis: a relationship with obesity?. J Bone Joint Surg 2008; 90: 92-94
• 3 Chung S, Batterman S, Brighton C. Shear strength of the human femoral capital epiphyseal plate. J Bone Joint Surg Am 1976; 58: 94-103
• 4 Gelberman RH, Cohen MS, Shaw BA. et al. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986; 68: 1000-1007
• 5 Schur MD, Andras LM, Broom AM. et al. Continuing delay in the diagnosis of slipped capital femoral epiphysis. J Pediatr 2016; 177: 250-254
• 6 Hefti F. Kinderorthopädie in der Praxis. 2. Aufl.. Heidelberg: Springer; 2006
• 7 Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am 1967; 49: 807-835
• 8 Loder RT. What is the cause of avascular necrosis in unstable slipped capital femoral epiphysis and what can be done to lower the rate?. J Pediatr Orthop 2013; 33: S88-S91
• 9 Aronsson DD, Loder RT, Breur GJ. et al. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 2006; 14: 666-679
• 10 Wright PB, Ruder J, Herrera-Soto JA. et al. Arthrogram-assisted fixation of slipped capital femoral epiphysis: a CT and radiographic study. J Pediatr Orthop 2012; 32: 693-696
• 11 Bono KT, Rubin MD, Jones KC. et al. A prospective comparison of computer-navigated and fluoroscopic-guided in situ fixation of slipped capital femoral. J Pediatr Orthop 2013; 33: 128-134
• 12 Sikora-Klak J, Bomar JD, Paik CN. et al. Comparison of surgical outcomes between a triplane proximal femoral osteotomy and the modified Dunn procedure for stable, moderate to severe slipped capital femoral epiphysis. J Pediatr Orthop 2017;
• 13 Tannast M, Jost LM, Lerch TD. et al. The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience. J Child Orthop 2017; 11: 138-146
• 14 Elmarghany M, Abd El-Ghaffar TM, Seddik M. et al. Surgical hip dislocation in treatment of slipped capital femoral epiphysis. SICOT J 2017; 3: 10
• 15 Loder RT. The demographics of slipped capital femoral epiphysis: an international multicenter study. Clin Orthop Related Res 1996; 322: 8-27
• 16 Kennedy JG, Hresko MT, Kasser JR. et al. Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis. J Pediatr Orthop 2001; 21: 189-193
• 17 Tokmakova KP, Stanton RP, Mason DE. Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis. J Bone Joint Surg Am 2003; 85: 798-801
• 18 Örtegren J, Peterson P, Svensson J. et al. Persisting CAM deformity is associated with early cartilage degeneration after Slipped Capital Femoral Epiphysis: 11-year follow-up including dGEMRIC. Osteoarthritis Cartilage 2018; 26: 557-563
• 19 Akiyama M, Nakashima Y, Kitano T. et al. Remodelling of femoral head-neck junction in slipped capital femoral epiphysis: a multicentre study. Int Orthop 2006; 37: 2331-2336
• 20 Ganz R, Parvizi J, Beck M. et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; 417: 112-120