Review Question - QID 946

The radiographs show a slipped capital femoral epiphysis (SCFE) of the right hip. Patients with endocrine disease such as hypothyroidism commonly demonstrate prevalence of bilaterality (as high as 80% in some reports), prophylactic treatment of the opposite hip should be considered. When adding additional risks of contralateral hip slip of obesity and young age and the significant morbidity of displacement of slipped capitol femoral epiphysis, the controversy of prophylactic contralateral pinning is diminished.

The general recommendations for prophylactic pinning include inability to obtain regular follow up, metabolic/endocrine disorders, open triradiate cartilage, girls younger than 10, and boys younger than 12.5 years.

Riad et al evaluated chronological age at presentation, sex, race and status of triradiate cartilage and a modified Oxford bone age were assessed. In this analysis, chronological age was the only significant predictor for developing a contralateral slip.

Loder et al reviewed 85 patients with endocrine disorders and slipped capital femoral epiphysis (SCFE). They found the average age at diagnosis was 13.2 years and only patients with hypothyroidism or growth hormone deficiency were diagnosed at ages less than 10 years. Because of the rate of SCFE occurring bilaterally, these authors recommend prophylactic pinning of the contralateral hip.

Schultz et al used a decision analysis model predicting the probabilities of occurrence of a contralateral slip and the associated severity of that slip to analyze the benefit of prophylactic pinning. Their data suggest that treatment of the contralateral hip with prophylactic pinning is beneficial to the long term outcome of that hip. As such, they recommend this treatment for patients at high risk of SCFE.