Long-term Evolution of Slipped Capital Femoral Epiphysis Treated by in Situ Fixation: A 26 Years Follow-up of 11 Hips.

Slipped capital femoral epiphysis (SFCE) may lead to femoro acetabular impingement and long-term function impairment, depending on initial displacement and treatment. There are several therapeutic options which include in situ fixation (ISF). The objective of this study was to evaluate long-term functional and radiographic outcomes of patients with SFCE treated with ISF. We conducted a single-center, retrospective study evaluating the clinical and radiographic outcomes of SCFE in situ fixation with a mean follow-up of 26 years (10-47). Analysis of preoperative and last follow up radiographs was performed. The functional status of the hip was evaluated according to the Oxford hip score-12 and the radiographic osteoarthritis stage was rated according to Tönnis classification. Signs of femoro acetabular impingement were sought. Ten patients (11 hips) were included. The average initial slip was 33.5° (10-62). At final follow up, the average Oxford hip score was 19.3 (12-37), it was good for groups who had a small initial slip (16.7) or moderate (17) and fair for the severe group (27). Average Tönnis grade was 1.3 (0-3). The average alpha angle was 65.3° (50-80°). Femoro acetabular impingement was likely in 100% of patients with severe slip, in 50% of patients with moderate slip and in 33% of patients with a slight slip. In situ fixation generated poor functional results, substantial hip osteoarthritis and potential femoro acetabular impingement in moderate to severe SCFE's. However, in cases with minor displacement, functional and radiographic results are satisfactory. The cut off seems to be around 30° slip angle, above which other treatment options should be considered.

Literature review and clinical presentation of bilateral acetabular fractures secondary to seizure attacks.

Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack.

Arthroscopic excision of intra-articular hip osteoid osteoma: a report of 2 cases.

Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results.

False aneurysm of the external iliac artery caused by aseptic loosening and migration of a cemented cup.

A 79 year old woman with bilateral hip replacements presented with severe left thigh swelling, and life threatening hypovolemic shock. After adequate resuscitation, an angio CT scan of her pelvis showed a false aneurysm of the external iliac artery in proximity to a loose pegged cemented cup. A pelvic X-ray 6 years prior to presentation had revealed a medialized high riding pegged cemented cup with a loose cemented stem. Vascular reconstruction followed by revision of the left THA was necessary.