Giovanni T et al. – This retrospective study aimed to analyze the long–term survivorship free from total hip replacement (THR) following combined epiphysiodesis and Imhauser intertrochanteric osteotomy (ITO). In majority of patients with moderate to severe slipped capital femoral epiphysis, combined epiphysiodesis and Imhauser ITO was concluded to be a valid surgical option, which may preserve the natural hip for at least 39 years. However, care must be taken to avoid avascular necrosis (AVN) or chondrolysis in patients who underwent surgery. Age at surgery was a negative prognosis factor.

Methods

• A total of 45 patients (hips, n = 53; male, n = 27; average age, 12.8 ± 1.9 years) with a posterior sloping angle >40 degrees (mean, 69 ± 16 degrees) underwent a combined epiphysiodesis and Imhauser ITO.
• The cumulative survivorship according to Kaplan and Meier was determined, with conversion to THR defined as the end point .

Results

• No postoperative complications were seen in 6 patients (6 hips; 11%) at a follow–up <2 years.
• A total of 4 early postoperative complications (2 AVN, 2 chondrolysis) were reported in remaining 39 patients (47 hips, 89%) with mean follow–up of 21 ± 11 years.
• Cumulative 39–year survivorship free from THR was 68.5% (95% confidence interval, 42.4%–84.7%).
• Long–term prognosis was affected by the age at surgery (hazard ratio [HR] = 1.849 per year older, P = .017) and the postoperative onset of AVN or chondrolysis (HR = 10.146, P = .010).