A retrospective research of factors affecting prognosis in the orthopedic treatment of patients with the slipped capital femoral epiphysis

The aim of this study is to examine the correlation of the effects of retrospectively analyzed preoperative laboratory findings, the stages detected in the radiographs taken at the time of admission to the hospital, gender, weight, age and side finding on the prognosis of patients with Slipped Capital Femoral Epiphysis, with clinical and radiological results. Method Patients who applied to Dicle University Faculty of Medicine between 2011-2021 and were found to have Slipped Capital Femoral Epiphysis after pelvic X-ray; preoperative blood values, preoperative radiographs, postoperative radiographs and postoperative radiographs taken during outpatient clinic follow-ups, hip joint examinations and leg length measurements were examined. In our study, 58 patients who were operated for Slipped Capital Femoral Epiphysis were reviewed retrospectively and the records of 27 patients were found sufficient and included in the study. Exclusion of patients from the study; Surgical open reduction or osteotomy other than in situ pinning, Revision surgery, follow-up period of less than 2 years, absence of epiphysiodesis and absence of primary or secondary musculoskeletal disease that would impair walking function of the patient were taken into consideration. Bilateral Slipped Capital Femoral Epiphysis was detected in 5 of 27 patients and surgery was performed on both hips, and 4 of them underwent prophylactic surgery on the contralateral hip due to risk factors, although Slipped Capital Femoral Epiphysis was detected in one hip. A total of 36 hips were operated on in 27 patients. The list of all people included in the study was obtained from the probel system. The necessary xray images of the patients were accessed via the Infinity system. Preoperative blood results of the patients included in our study, preoperative and postoperative X-rays, hip joint examinations and leg length measurements were made and the measurements we determined for statistical data analysis were made and noted. x Results In our study, we had a total of 27 patients of different ages and genders. The total number of hip operations in these 27 patients was 36. When these 27 patients were compared in terms of gender, 19 (70.4%) were male and 8 (29.6%) were female. When the preoperative body weights of 27 patients were compared; since all of our patients were under the age of 18, height and weight were evaluated using the percentile table. Values below the 5th percentile were considered weak and we had no patients. 5-85 percentile was normal weight with 5 (18.5%) hips, 85-95th percentile was medium weight with 10 (37%) hips. It was considered obese above the 95th percentile and had 12 (44.4%) hips. When 27 of our patients were evaluated preoperatively, Slipped Capital Femoral Epiphysis was detected in the right hip in 14 (51.9%) patients, while Slipped Capital Femoral Epiphysis was detected in the left hip in 13 (48.1%) patients. Considering the symptom duration of the patients before surgery, the number of patients with acute shift was 22 (81%), and the number of acute shift to chronic was 5 (19%). We did not have a patient with chronic shift. The degree of deviation of the patients was measured according to the Southwick method on AP and lateral radiographs. The amount of slip was considered mild in those 30 degrees and below, moderate slips between 31 degrees and 50 degrees, and severe slippages greater than 50 degrees. Although the current number of patients is 27, bilateral Slipped Capital Femoral Epiphysis was detected in 5 patients and in 4 patients, in situ pinning was performed on the contralateral hip as a prophylactic, due to the presence of risk factors despite unilateral Slipped Capital Femoral Epiphysis. In our patient group, whose total number of hips intervened was 36, 12 (33.3%) patients with mild, 13 (36.1%) patients with moderate and 11 (30.6%) patients with severe severity were evaluated according to the Southwick classification. When the patients with bilateral Slipped Capital Femoral Epiphysis and prophylactically pinned contralateral side were taken into consideration separately and the total number of operated hips was evaluated as 36 in our 27 patients, the mean age was 12.7 according to the data obtained. When the evaluation is made according to the radiographs taken in the outpatient clinic controls after the follow-up period of the patients is completed, 36 operated hips will be evaluated separately, The number of patients who developed AVN was 15 (41.7%), and the number of patients who did not develop AVN was 21 (58.3%). The number of patients who developed chondrolysis was 16 (44.4%), and the number of patients who did not develop chondrolysis was 20 (55.6%). The data obtained in the evaluations of the patients according to the Harris hip scoring were 11 (30.6%) patients with moderate level, 6 (16.7%) patients with good level, and 19 patients with very good level (52.8%). There was no patient in the bad and excellent group. In the leg length measurements made after the post-operative follow-up of the patients was completed, when compared to the opposite extremity there was no difference in xi shortness in 14 (51.9%) of 27 patients. 12 (44.4%) had a shortness of 1-2 cm. There was 2 cm shortness in 1 (3.7%) patient. A significant correlation was found between overweight and the development of chondrolysis (p<0.05). It was determined that patients with moderate weight and obesity applied with a more advanced stage according to the Southwick stage classification and there was a significant correlation between them (p<0.05). A significant correlation was found with the risk of developing AVN in patients with advanced stage according to the Southwick classification, which was determined in the measurements made according to the pelvic ap and lateral radiographs taken at the time of admission to the hospital (p<0.05). A significant correlation was found with the risk of developing chondrolysis in patients with advanced stage according to the Southwick classification, which was determined in the measurements made according to the pelvic ap and lateral radiographs taken at the time of admission to the hospital (p<0.05). It was determined that patients with advanced stage according to the Southwick classification, which were detected in the measurements made according to the pelvic ap and lateral radiographs taken at the time of admission to the hospital, were at lower stages in the Harris Hip Scoring and there was a significant correlation between them (p<0.05). It was observed that the prognosis was affected in patients with LDH value, Monocyte value and Albumin/LDH ratio above a certain level, and after the follow-up period of the patients was completed, they applied to the outpatient clinic at lower stages compared to the Harris Hip Score, and a significant correlation was found between them (p<0.05). Conclusion Based on the data we obtained at the end of the study, it was found that being overweight or obese has an effect on the prognosis in patients with Slipped Capital Femoral Epiphysis, in the Southwick stage classification, which was evaluated according to the radiographs taken at the time of admission to the hospital, it was found that there was a significant relationship between the progression of the slip level and the prognosis and it was evaluated that the laboratory findings of Monocyte, Albumin/LDH and LDH values above a certain level may have effects on the prognosis. Key Words: Slipped Capital Femoral Epiphysis, Southwick Classification, LDH, Monosit, Albümin/LDH