VOL. 88-B, No. 10, OCTOBER 2006 1379
Outcomes of subcapital cuneiform osteotomy
for the treatment of severe slipped capital
femoral epiphysis after skeletal maturity
G. S. Biring,
From the Royal
A. Catterall, MChir,
Royal National Orthopaedic
Hospital, Brockley Hill,
Stanmore, Middlesex HA7 4LP,
G. S. Biring, MSc Ortho. Eng.,
Correspondence should be sent
to Mr A. Hashemi-Nejad;
©2006 British Editorial Society
of Bone and Joint Surgery
J Bone Joint Surg [Br]
Received 6 February 2006;
Accepted after revision 18 May
We reviewed prospectively, after skeletal maturity, a series of 24 patients (25 hips) with
severe acute-on-chronic slipped capital femoral epiphysis which had been treated by
subcapital cuneiform osteotomy. Patients were followed up for a mean of 8 years, 3 months
(2 years, 5 months to 16 years, 4 months). Bedrest with ‘slings and springs’ had been used
for a mean of 22 days (19 to 35) in 22 patients, and bedrest alone in two, before definitive
surgery. The Iowa hip score, the Harris hip score and Boyer’s radiological classification for
degenerative disease were used.
The mean Iowa hip score at follow-up was 93.7 (69 to 100) and the mean Harris hip score
95.6 (78 to 100). Degenerative joint changes were graded as 0 in 19 hips, grade 1 in four and
grade 2 in two. The rate of avascular necrosis was 12% (3 of 25) and the rate of chondrolysis
was 16% (4 of 25). We conclude that after a period of bed rest with slings and springs for
three weeks to gain stability, subcapital cuneiform osteotomy for severe acute-on-chronic
slipped capital femoral epiphysis is a satisfactory method of treatment with an acceptable
rate of complication.
The treatment of severe slipped capital femoral
epiphysis (SCFE) is controversial and often dif-
Severe cases comprise approximately
5% to 10% of all cases of SCFE,
eral the long-term results of these slips treated
by any method are poor.
The aims of treatment are to prevent further
epiphyseal displacement, to avoid complica-
tions such as avascular necrosis and chondro-
lysis, to correct the deformity and to maintain
hip function. The importance of SCFE in the
aetiology of osteoarthritis of the hip in the
adult has been recognised.
question as to whether reduction of the deform-
ity can reduce the severity, and delay the onset,
of symptoms in adults.
Possible treatments available for severe
SCFE are pinning
proximal femoral osteotomy. The last can be
performed at the physis,
or at the intertrochanteric/
ment is almost complete at presentation in this
group of patients and therefore the potential
for acetabular remodelling is limited. The meta-
physis may impinge on the lateral rim of the
acetabulum and lead to accelerated degenera-
tion. The purpose of a subcapital cuneiform
osteotomy as described by Fish
this severe deformity at the time of initial treat-
and in gen-
This raises the
, epiphysiodesis or
at the base of the
is to correct
ment since it is unlikely to remodel. The osteot-
omy restores the normal relationship of the
head, neck and shaft, thereby potentially
improving kinematics and preventing or delay-
ing the onset of osteoarthritis. Such a joint
would be expected to function normally in the
short and long term.
Our aim was to review the clinical and
radiological results of subcapital cuneiform
osteotomy at skeletal maturity.
Patients and Methods
Between 1989 and 2003, 26 patients under-
went subcapital cuneiform osteotomy at our
institution. Two were lost to follow-up. A
series of 25 hips in 24 patients was therefore
available for prospective clinical and radio-
logical review at a mean follow-up of eight
years three months (2 years 5 months to 16
years 4 months).
There were 15 boys and nine girls with a
mean age at presentation of 13.8 years (11.3 to
15.7). Girls presented earlier, at a mean of 12.1
years (11.3 to 13.6), than boys at 14.8 years
(13.3 to 15.7). The mean age at follow-up was
21.5 years (14 to 34). There were 13 left hips
and 12 right. One patient had hypothyroidism.
The slip was classified into categories based
on duration of symptoms (acute, acute-on-
chronic or chronic), the angle of slip (mild,
1384 G. S. BIRING, A. HASHEMI-NEJAD, A. CATTERALL
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