[Early and late complications and their management in slipped capital femoral epiphysis]. / Früh- und Spätkomplikationen sowie deren Management bei der ECF.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) remains a challenge for the treating surgeon. First of all, SCFE should be diagnosed as early as possible. The earlier the diagnosis is made in adolescents, the lower the slip angle will be. Mild slips show more favourable long-term courses than moderate and severe SCFE. COMPLICATIONS: With increasing slip angle, the risk of complications increases. The complications of SCFE are diverse, the most severe of which are avascular necrosis (AVN) and chondrolysis. AVN is more common in surgically treated than in non-operatively managed patients and unstable SCFE bears the highest risk of AVN. THERAPY: Adequate treatment of AVN is still controversial. For surgical treatments, variable rates of AVN have been reported. There is a wide spectrum of surgeries for treating AVN, from hip joint-preserving techniques to total hip replacement. In central Europe there is wide consensus in favour of treating the contralateral side, but this is not without complications. Surgical treatment with in-situ pinning must be carried out with great care to take into consideration the morphology of the femoral head and not to perforate it. It should always be ensured that no osteosynthesis material penetrates the hip joint.

Stem cell therapy combined with core decompression versus core decompression alone in the treatment of avascular necrosis of the femoral head: a systematic review and meta-analysis.

INTRODUCTION: Accumulated clinical trials had been focused on stem cell therapy in combination of core decompression (CD) in the treatment of avascular necrosis of the femoral head (ANFH). Nonetheless, the results were inconclusive. Here, we performed a systematic review and meta-analysis of previous randomized controlled trials (RCTs) and retrospective studies to assess whether combined stem cell augmentation with CD improved the outcomes of ANFH compared with CD alone. METHODS: The current study included 11 RCTs and 7 retrospective studies reporting the clinical outcomes of a total of 916 patients and 1257 hips. 557 and 700 hips received CD and CD plus stem cell therapy, respectively. To compare CD with CD plus stem cell therapy, we examined the clinical evaluating scores, the occurrence of the femoral head, radiologic progression and conversion to total hip arthroplasty (THA). RESULTS: Only 10 studies reported significantly greater improvement in hip functions while combining stem cell procedure with CD. The pooled results in subgroup analysis indicated that stem cell group had a lower collapse rate on a mid-term basis (P = 0.001), when combined with mechanical support (P < 0.00001), and with extracted stem cells (P = 0.0002). Likewise, stem cell group had a lower radiographic progression rate at 2- to 5-year follow-up [P = 0.003], when combined with structural grafting (P < 0.00001), and with extracted stem cells (P = 0.004). Stem cell therapy resulted in an overall lower THA conversion rate (P < 0.0001) except that at a follow-up longer than 5 years. CONCLUSION: Stem cell therapy combined with core decompression was more effective in preventing collapse, radiographic progression and conversion to THA. Trial Registration The current protocol has been registered in PROSPERO with the registration number: CRD42023417248.

Bilateral idiopathic osteonecrosis of the femoral head: a case report with an emphasis on differential diagnosis, imaging, and treatment.

OBJECTIVE: The purpose of this case report is to describe a patient with bilateral idiopathic osteonecrosis of the femoral head (ONFH), provide a discussion of differential diagnosis for anterior hip pain, imaging, and treatment recommendations for ONFH. CLINICAL FEATURES: A 34-year-old man was initially treated by a chiropractic physician for low back pain. At the end of a three week trial of care, the patient's low back pain resolved. However, he reported a new complaint of mild left anterior hip stiffness. After re-examination, a homecare exercise program was prescribed. The patient returned 1 month later with substantial left anterior hip pain and walked with a noticeable limp. Radiography of the left hip demonstrated advanced ONFH. Magnetic resonance imaging of both hips demonstrated the extent of involvement of the left hip while incidentally revealing ONFH on the right. INTERVENTION AND OUTCOME: A total hip arthroplasty was performed on the left hip and the right hip is being monitored without intervention. CONCLUSION: Osteonecrosis of the femoral head is a challenging clinical problem with non-specific and wide-ranging signs and symptoms requiring clinicians to engage a cautious and comprehensive differential diagnosis. Prompt recognition ensures that appropriate treatment can be initiated in a timely manner and optimal patient outcomes achieved.