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Children's Orthopaedics: M. M. Mullins, M. Sood, A. Hashemi-Nejad, and A. Catterall The management of avascular necrosis after slipped capital femoral epiphysis J Bone Joint Surg Br 2005; 87-B: 1669-1674 [Abstract] [Full text] [PDF]

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The management of avascular necrosis after slipped capital femoral epiphysis

Mark M Mullins   (6 March 2006)

The management of avascular necrosis after slipped capital femoral epiphysis

Skand Kumar, Princess Royal Hospital, Haywards Heath, UK   (6 March 2006)

The management of avascular necrosis after slipped capital femoral epiphysis 6 March 2006
Mark M Mullins Send letter to journal: Re: The management of avascular necrosis after slipped capital femoral epiphysis mark{at}mullins71.fsnet.co.uk Mark M Mullins	Sir, We would like to thank Mr Kumar for his interest in our paper. The reason for our surgical interventions was to attempt to treat avascular necrosis that had already occurred. All the comments about small numbers and lack of comparative groups are valid, however this represents the entire experience of one of the national paediatric centres over a large number of years, so larger studies are unlikely to be forthcoming. M.M. Mullins, Specialist Registrar, The Royal National Orthopaedic Hospital, Stanmore, UK.
The management of avascular necrosis after slipped capital femoral epiphysis 6 March 2006
Skand Kumar, Registrar, Orthopaedics MS Orth, MRCS, Princess Royal Hospital, Haywards Heath, UK Send letter to journal: Re: The management of avascular necrosis after slipped capital femoral epiphysis skandkumar{at}gmail.com Skand Kumar, et al.	Sir, I read this article with interest. It highlights a serious and uncommon condition but the following points are unclear: 1/ Did avascular necrosis occur in these patients before the primary procedure? 2/ The distribution amongst the primary procedure. 3/ The reason for the delay in surgery. Fourteen patients had joint-preserving surgery with a significant improvement in hip score for only one year. Three had repeat proximal femoral osteotomies. Five had a subsequent THR. In this group, one patient had failure of repeat osteotomy, resulting in nine failures in 14 patients (64%). Most of the patients had a progressively improving hip score even though some had undergone subsequent procedures. Survival analysis was plotted for 14 patients but effectively only nine patients (64%) had joint-preserving surgery. The figure in the article shows the persistently uncovered deformed femoral head. In such reports with small numbers of patients, it would be more useful to have a table indicating scores, range of movements and other important clinical parameters before and after each procedure. A proximal femoral osteotomy is a major procedure with implications for the placement of components and outcome when patients eventually need THR.1 Many patients in the past have been treated conservatively for similar reasons and therefore a comparison study with those patients over this period of time would be more helpful. S. Kumar, Registrar, Orthopaedics, Princess Royal Hospital, Haywards Heath, UK. 1.Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg [Am]1991;73-A:667-74.