CUNEIFORM OSTEOTOMY OF THE FEMORAL-NECK IN SEVERE SLIPPED CAPITAL FEMORAL EPIPHYSIS

From 1978 through 1988, 27 severe slipped epiphyses (Grade III) in 23 adolescent patients were treated with a cuneiform osteotomy of the pro ximal neck of the femur Average time of followup was 8 years 5 months. The results were graded by the criteria of Southwick, with emphasis o n pain, function, range of motion, and radiographic appearance. Arbitr arily, no hips were rated excellent, because the authors thought that this rating should be reserved for normal hips that have not had any d isease process nor surgical procedure. There were 19 good, 4 fair, and 4 poor results. The 4 poor results were in patients with avascular ne crosis, The avascular necrosis rate nas 15%. Eight hips had some joint space narrowing during the postoperative followup period. All joint s pace narrowing was resolved by 20 months postoperatively. All patients , including those with avascular necrosis, improved in joint flexion a nd joint internal rotation. Although the avascular necrosis rate of 15 % is significant, the authors believe that the potential for restoring hip anatomy and providing a normally functioning hip in the adolescen t patient makes this procedure a viable treatment option.