Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 515-527
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.515
Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable: A systematic review
Steven J C Vink, Renée A van Stralen, Sophie Moerman, Christiaan J A van Bergen
Steven J C Vink, Renée A van Stralen, Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam 3015GD, Netherlands
Sophie Moerman, Department of Orthopedic Surgery, University Medical Center Groningen, Groningen 9713GZ, Netherlands
Christiaan J A van Bergen, Department of Orthopedic Surgery, Amphia Hospital, Breda 4818CK, Netherlands
Author contributions: Vink SJC drafted and finalized the manuscript; van Stralen RA and Moerman S contributed to the data collection; van Bergen CJA supervised the writing process; All authors contributed to the inclusion and assessment of the study quality of eligible articles, reviewed and commented on the text and approved the final version.
Conflict-of-interest statement: The authors declare no conflict of interests for this article. This study did not receive funding.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Steven J C Vink, MD, Department of Orthopedic Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam 3015GD, Netherlands.
Received: October 12, 2021
Peer-review started: October 12, 2021
First decision: March 7, 2022
Revised: March 21, 2022
Accepted: April 25, 2022
Article in press: April 25, 2022
Published online: May 18, 2022
Research background

Slipped capital femoral epiphysis (SCFE) is an important medical condition occurring in adolescents. It may cause severe short and long term complications. At present, there is no clear consensus on whether or not to prophylactically fixate the unaffected side in unilateral SCFE. The current review provides a comprehensive assessment of the deliberations to be made when treating this condition.

Research motivation

The risks of subsequent contralateral slipping after primary unilateral SCFE are discussed. Consequently, the advantages, but also the risks, rendered by prophylactic fixation are outlined.

Research objectives

The risk rates of subsequent contralateral slipping and its sequelae after primary unilateral SCFE are evaluated. Several imaging modalities and their interpretation in regard to the risk assessment are presented. The advantages and disadvantages of prophylactic pinning are evaluated and an overall outline is presented as to the treatment strategy.

Research methods

A systematic review of the literature was performed and the results were presented in a qualitative manner with descriptive statistics.

Research results

When presenting with unilateral SCFE, a patient has a 2335 times increased likelihood of developing a consecutive contralateral slip, with 14% developing a symptomatic and 38% asymptomatic slip. Both clinical and subclinical slips are at an increased risk of developing harmful sequelae of the hip. Prophylactic pinning of the contralateral side negates the development of such sequelae. This surgical intervention renders complications such as infection, avascular necrosis, implant related problems and morphologic changes, albeit only at very low rates. A number of methods to assess the risk of a contralateral slip have been described in the current literature, most significantly the posterior sloping angle (PSA) on plain radiographs.

Research conclusions

A substantial rate of patients presenting with unilateral SCFE develop a contralateral slip, posing an increased risk to developing harmful sequelae. The advantages of negating these developments by prophylactic pinning of the primarily unaffected side appear to be outweighing the infrequently occurring disadvantages of the surgical intervention. The decision remains to be patient-tailored and can be aided by evaluation of the PSA on plain radiographs.

Research perspectives

Additional studies evaluating a watchful waiting strategy that elaborate on the severity of subsequent slips and its sequelae may prove insightful to better weigh this against the surgery associated risks. In addition, further research directly comparing the short and long term outcomes of watchful waiting and prophylactic pinning may aid in formulating an unambiguous treatment strategy. Also, research concerning the risks for developing a primary SCFE may further the prevention of the condition arising in the first place in the adolescent population, thereby improving their long term functioning.