Complete Slippage of Capital Femoral Epiphysis: Total Hip Arthroplasty with Custom-Made Stem Martijn RAAIJMAAKERS , Franky Steenbrugge , Michiel MULIER Ortop Traumatol Rehabil 2010; 12(2):160-165 ICID: 909945
Article type: Case report
IC™ Value: 4.54
Abstract provided by Publisher
Introduction Slipped capital femoral epiphysis occurs in adolescents, most often shortly after the onset of puberty. In patients suffering form renal osteodystrophy, the incidence is higher and the condition usually occurs at a younger age. Metabolic changes induce weakening of the bone, which makes the hip joint vulnerable. The initial treatment consists of phosphate-restricted diet, lanthanum carbonate, cinacalcet (a calcimimetic), calcium carbonate and oral calcitriol, aiming at restoration of bone quality. The use of several surgical treatment options has been reported. Materials and methods
In this case, which was diagnosed at a later age because no radiographic work-up was performed in the patient’s homeland, the only possible treatment option was a total hip arthroplasty. The use of a commercially available femoral stem was impossible because of the abnormal anatomy of the proximal femur. This patient was treated with a custom stem prosthesis manufactured intraoperatively. Results Six weeks post surgery, HHS and VAS were improved. Ten weeks post surgery a fracture of the femoral diaphysis was treated with revision surgery using a 20 cm long custom-made stem. At 12 weeks post surgery progressive physical therapy is being instituted.
Conclusion Timely detection of slipped capital femoral epiphysis is a cornerstone of adequate management. In this specific case, the diagnosis was missed and salvage treatment required total hip arthroplasty with a stem prosthesis adapted to the patient’s anatomy.
ICID 909945 PMID 20453255 - click here to show this article in PubMed