Carney and Weinstein described the long‑term course of chronic slipped capital femoral epiphysis left untreated.
University of Iowa series of 31 untreated chronic slips in 28 patients seen from 1915 to 1952, followed a mean 41 years from symptom onset.
Key Findings
All 13 moderate or severe slips with radiographs had degenerative changes, vs 9 of 14 mild slips. Five mild slips (36%) had none (p = 0.025).
All 17 mild slips had an Iowa Hip Rating of 80 or more, while 5 of 14 moderate or severe slips scored below 80 (p = 0.012).
Mean Iowa Hip Rating was 92 for mild, 87 for moderate and 75 for severe slips, 89 overall.
Complications occurred in 4 slips: 2 progressed to severe displacement, 1 mild slip developed chondrolysis and 1 severe slip developed osteonecrosis.
In the authors' earlier series, 6 of 35 observed slips (17%) displaced further, 5 to a severe degree. Slips stabilized surgically, including 11 acute‑on‑chronic slips that all became severe, were excluded here.
Reasons for nontreatment, where recorded, were late presentation, family refusal or a worse opposite slip. Four patients lacked follow‑up radiographs.
Board pearl
In untreated chronic SCFE, greater displacement predicted arthritis. Every moderate or severe slip showed degenerative change at about 41 years. Mild slips kept Iowa Hip Ratings of 80 or more, though 9 of 14 showed some degenerative change.
Authors' conclusion
The natural history of chronic slipped capital femoral epiphysis is favorable provided that displacement is minimal and remains so.
Carney and Weinstein described the long‑term course of chronic slipped capital femoral epiphysis left untreated.
University of Iowa series of 31 untreated chronic slips in 28 patients seen from 1915 to 1952, followed a mean 41 years from symptom onset.
Key Findings
All 13 moderate or severe slips with radiographs had degenerative changes, vs 9 of 14 mild slips. Five mild slips (36%) had none (p = 0.025).
All 17 mild slips had an Iowa Hip Rating of 80 or more, while 5 of 14 moderate or severe slips scored below 80 (p = 0.012).
Mean Iowa Hip Rating was 92 for mild, 87 for moderate and 75 for severe slips, 89 overall.
Complications occurred in 4 slips: 2 progressed to severe displacement, 1 mild slip developed chondrolysis and 1 severe slip developed osteonecrosis.
In the authors' earlier series, 6 of 35 observed slips (17%) displaced further, 5 to a severe degree. Slips stabilized surgically, including 11 acute‑on‑chronic slips that all became severe, were excluded here.
Reasons for nontreatment, where recorded, were late presentation, family refusal or a worse opposite slip. Four patients lacked follow‑up radiographs.
Board pearl
In untreated chronic SCFE, greater displacement predicted arthritis. Every moderate or severe slip showed degenerative change at about 41 years. Mild slips kept Iowa Hip Ratings of 80 or more, though 9 of 14 showed some degenerative change.
Authors' conclusion
The natural history of chronic slipped capital femoral epiphysis is favorable provided that displacement is minimal and remains so.