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Basicervical osteotomy combined to cervicoplasty for the treatment of slipped capital femoral epiphysis: comparison of results with capital realignment and in situ fixation techniques

Grant number: 16/04376-3
Support type:Scholarships abroad - Research
Effective date (Start): July 18, 2016
Effective date (End): July 17, 2017
Field of knowledge:Health Sciences - Medicine
Principal researcher:Daniel Augusto Carvalho Maranho
Grantee:Daniel Augusto Carvalho Maranho
Host: Young-Jo Kim
Home Institution: Fundação de Apoio ao Ensino, Pesquisa e Assistência (FAEPA). Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP (HCMRP). Secretaria da Saúde (São Paulo - Estado). Ribeirão Preto , SP, Brazil
Research place: Harvard University, Boston, United States  


Introduction: The slipped capital femoral epiphysis (SCFE) is the most common acquired condition of the adolescent hip, and is related to pain, femoroacetabular impingement and early osteoarthritis. Controversies exist regarding treatment and, in general, studies evaluate case series treated with a particular technique, with limitations related to the lack of comparison among treatment modalities. In situ fixation (ISF) is one of the most used method for treatment, despite the remaining of residual articular deformities. Ideally, it is performed in mild displacements. Moderate and severe displacements benefit with realignment osteotomies. Avascular necrosis (AVN) is the most severe complication, and it is related to the epiphysis instability and the level of osteotomy. Realignment at the growth plate level may anatomically solve the displacement, but with risk of AVN. A recent technical modification for anatomical capital realignment (CR) might provide optimal correction, supposedly with lower risk of AVN, but requires a long learning curve. Osteotomies distant from the deformity might improve the alignment with a lower risk of AVN but predispose to residual metaphyseal bump. Aditionally, cervicoplasty might be used to remove the residual articular deformity and prevent femoroacetabular impingement. The purpose of this study is to present the association of basocervical osteotomy and cervicoplasty (BCC) for the treatment of SCFE.Justification:There is equipoise regarding the SCFE treatment. Despite CR has major potential of correction, its is related to poor results secondary to AVN in up to one third of patients. In the other hand, osteotomies performed distant from the deformity site, when associated with removal of femoroacetabular impingement deformities using cervicoplasty, might lead to excellent outcomes, without the risk of avascular necrosis, despite the remaining of residual deformities. There is no comparative study among the two modalities, and there are no evidences regarding which results are safer and more functionally favorable.The presentation of BCC, and the comparison would be innovative and original in literature, and the major justification of the project is the prospective evaluation of the hypothesis that outcomes of BCC would be similar to CR. If BCC shows favorable clinical results, its surgical decision making would be reinforced within the international literature, because of the lower risk of AVN, when compared to CR.Objectives: 1. Evaluate treatment outcomes of moderate and severe SCFE after treatment by BCC and CR techniques. Evaluation of mild SCFE and healthy non-affected hips compose the comparative and control groups.2. Compare outcomes among surgical techniques, and define if BCC group result in equivalent, inferior or superior outcomes when compared to CR, ISF, and control.MethodsThis is a prospective cohort study approved by the Research Ethical Committee with a consecutive inclusion of patients in two centers. Age vary from 8 to 21 years, regardless gender, and the inclusion criteria are patients who underwent one of the procedure: BCC, CR, ou ISF, with minimum follow-up of four years. Exclusion criteria are different type of osteotomy, cognitive impairment, and non-acceptance for participation in the research. Clinical evaluation will be performed at 6 months, 1, 2 and 4 years after surgery. Each evaluation will include the range of motion of the hip joint (goniometry), test for gluteus medius insufficiency (Trendelenburg), femoroacetabular impingement test, functional evaluation with Harris Hip Score and FS12 protocols. The muscle force will be evaluated with isokinetic dynamometer at 60º and 120º/s. Radiographic evaluation will include pelvic radiographs with anteroposterior incidence, Lauenstein, elongated neck lateral view. The avascular necrosis presence, cervicoepiphyseal angle, Southwick angle, coxa brevis presence, and trochanteric height will be evaluated.

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
ANGELICO, A. C. C.; GARCIA, L. M.; ICUMA, T. R.; HERRERO, C. F.; MARANHO, D. A. The results of osteotomy at the base of femoral neck with osteoplasty in restoration of abductor function and strength in slipped capital femoral epiphysis. BONE & JOINT JOURNAL, v. 100B, n. 11, p. 1524-1532, NOV 2018. Web of Science Citations: 1.
MARANHO, DANIEL A.; MILLER, PATRICIA E.; NOVAIS, EDUARDO N. The Peritubercle Lucency Sign is a Common and Early Radiographic Finding in Slipped Capital Femoral Epiphysis. JOURNAL OF PEDIATRIC ORTHOPAEDICS, v. 38, n. 7, p. E371-E376, AUG 2018. Web of Science Citations: 2.
NOVAIS, EDUARDO N.; MARANHO, DANIEL A.; KIM, YOUNG-JO; KIAPOUR, ATA. Age- and Sex-Specific Morphologic Variations of Capital Femoral Epiphysis Growth in Children and Adolescents Without Hip Disorders. ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, v. 6, n. 6 JUN 25 2018. Web of Science Citations: 1.

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