Five hundred thirty-two cases of slipped capital femoral epiphysis (physiolysis colli femoris--PCF) treated at three orthopedic departments in southern Sweden between 1910 and 1982 were used for epidemiologic studies. Three hundred twenty-five cases came from a well-defined area and were used for incidence analyses. During the whole period of investigation, the disease was more common in men than in women. The difference was more pronounced in the earlier years of the investigation and among patients living in the country compared with patients living in the city. The mean age at onset of slipping has decreased in men from 16.0 to 12.7 years and has decreased in women from 12.6 to 11.8 years since the beginning of the century. The left hip is affected more often than is the right, especially in men, but during the past decades there has been a tendency toward equalization. Bilateral slipping was evident in 25.4% of the men and in 17.7% of the women. Men living outside the city were at higher risk for bilateral involvement than were men living in the city. In women, the situation was the opposite. The incidence has followed a periodic pattern with peaks approximately every 20th year. The mean incidence (number of cases/10,000 living born) during the period of growth was 6.1 in men and 3.0 in women. The maximal risk is supposed to be 25.7 in men and 20.5 in women. Men living in the country have always been at higher risk compared with men living in the city. Since the fifties, the incidence in women has also been higher in those living in the country. In women, the incidence was significantly higher between May and August. No seasonal variations were seen in men.
In 1994 a cerebral palsy (CP) register and healthcare programme was established in southern Sweden with the primary aim of preventing dislocation of the hip in these children. The results from the first ten years were published in 2005 and showed a decrease in the incidence of dislocation of the hip, from 8% in a historical control group of 103 children born between 1990 and 1991 to 0.5% in a group of 258 children born between 1992 and 1997. These two cohorts have now been re-evaluated and an additional group of 431 children born between 1998 and 2007 has been added. By 1 January 2014, nine children in the control group, two in the first study group and none in the second study group had developed a dislocated hip (p
Opinions differ concerning the treatment of choice for severe slipped capital femoral epiphysis, probably due to the lack of long-term follow-up evaluations on the different methods of treatment. A series of 33 patients with severe slipped capital femoral epiphysis, treated per primam with wedge osteotomy of the femoral neck, were radiographically and clinically reexamined an average of 28 years (range, 16-32 years) after the operation. Segmental collapse and/or chondrolysis developed in ten patients. Nine of these patients were available for reexamination and all had severe arthrosis with poor function. Arthrosis developed in nine of the 19 patients without signs of segmental collapse or chondrolysis; these patients had a satisfactory joint function. This series was compared with another series (from the same orthopedic departments) of patients with severe slip without any primary treatment. The long-term results in these two groups were similar; consequently, the value of realignment by wedge osteotomy of the femoral neck is questionable.
One hundred seventy-two patients with 204 slipped capital femoral epiphyses treated with nailing or pinning were evaluated an average of 28 years after surgery. Follow-up evaluation was obtained by questionnaire in 153 cases (181 hips) and by clinical and radiographic reexamination in 132 cases (157 hips). Segmental collapse was seen in four of 179 hips nailed/pinned in situ and in four of 25 hips operated after reduction. This was the only early complication associated with problems at reexamination. Arthrosis was twice as frequent after reduction (53%) than after fixation in situ (24%). The clinical and radiographic results were better than those from the same region after other methods of treatment. Nailing or pinning in situ is the method of choice when possible, regardless of the degree of slipping. Bilateral slipping was found in 67% of the hips; therefore, prophylactic pinning of the contralateral hip is indicated in cases with unilateral slipping.