Research Article
BibTex RIS Cite

Correlation of Functional and Radiological Results with Three-Dimensional Gait Analysis in Patients with Unilateral Slipped Capital Femoral Epiphysis

Year 2020, Volume: 4 Issue: 2, 161 - 168, 12.07.2020
https://doi.org/10.30565/medalanya.694570

Abstract

Aim: The aim of this study was to evaluate the correlation between gait analysis and clinical and radiographic results in patients operated for slipped capital femoral epiphysis (SCFE).

Materials and Methods: This study included 31 patients with unilateral SCFE. The mean follow-up time was 3.3 ± 1.4 years. Harris hip score (HHS) and the Pediatric Outcomes Data Collection Instruments (PODCI) scores were collected. Slip-angle, alpha-angle, lateral femoral head ratio (LFHR), articulotrochanteric distance (ATD), anteroposterior plane femoral head ratio (AP-FHR), anterior head-neck offset ratio (HNOR), and neck-shaft angle (NSA) were measured. An age-matched control group consisting of 20 healthy individuals was used for comparison. 

Results: Transfer and basic mobility subscale of PODCI was correlated with pelvis tilt ROM (r = −0.7, p < 0.001), foot progression angle (FPA) ROM (r =−0.4, p=0.02), and mean spine tilt (r=−0.6, p<0.001). FPA was also correlated with the HHS (r=−0.5, p<0.001) and pain/comfort subscale of PODCI (r=−0.5, p=0.015). Significant correlations were detected between LFHR and mean hip flexion (r=−0.5, p<0.001), pelvic tilt (r=−0.4, p=0.04), and mean spine tilt (r=0.6, p<0.001). Correlations between ATD and mean internal rotation of the hip (r=0.5, p=0.03) and mean dorsal ankle extension (r=−0.4, p=0.03) were also significant. No significant correlation was found between the alpha angle, AP-FHR, and HNOR with the kinematic values.

Conclusion: Clinical scores of patients treated for SCFE were mostly correlated with pelvic tilt ROM, FPA, and spine tilt. LFHR and ATD were observed as the most critical radiological measurements related to a patient’s gait function.

References

  • 1. Krauspe R, Weinstein S. Special symposium issue: slipped capital femoral epiphysis (SCFE). J Child Orthop. 2017;11(2):85-86. DOI: 10.1302/1863-2548-11-170032
  • 2. Cooper AP, Salih S, Geddis C, Foster P, Fernandes JA, Madan SS. The oblique plane deformity in slipped capital femoral epiphysis. J Child Orthop. 2014;8(2): 121-7. DOI: 10.1007/s11832-014-0559-2
  • 3. Lehmann TG, Engesæter I, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. Radiological findings that may indicate a prior silent slipped capital femoral epiphysis in a cohort of 2072 young adults. Bone Joint J. 2013;95B(4):452-8. DOI: 10.1302/0301-620X.95B4.29910
  • 4. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39 Suppl:36S-42S. DOI: 10.1177/0363546511413993
  • 5. Brisson N, Lamontagne M, Kennedy MJ, Beaule PE. The effects of cam femoroacetabular impingement corrective surgery on lower-extremity gait biomechanics. Gait Posture. 2013;37(2):258-63. DOI: 10.1016/j.gaitpost.2012.07.016
  • 6. Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait walking biomechanics of FAI. Gait Posture. 2009;30(1):41-4. DOI: 10.1016/j.gaitpost.2009.02.008
  • 7. Rylander J, Shu B, Favre J, Safran M, Andriacchi T. Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome. J Orthop Res. 2013;3(9):1461-8. DOI: 10.1002/jor.22375
  • 8. Westhoff B, Ruhe K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome. Int Orthop. 2012;36(5):1031-1038. DOI: 10.1007/s00264-011-1409-1
  • 9. Seller K, Wild A, Westhoff B, Raab P, Krauspe R. Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis. Int Orthop. 2006;30(5):342-347. DOI: 10.1007/s00264-006-0110-2 

  • 10. Song KM, Halliday S, Reilly C, Keezel W. Gait abnormalities following slipped capital femoral epiphysis. J Pediatr Orthop 2004;24(2):148-155. PMID: 15076598
  • 11. Westhoff B, Schröder K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. Radiological outcome and gait function of SCFE patients after growth arrest. J Child Orthop. 2013;7(6):507-512. DOI: 10.1007/s11832-013-0528-1
  • 12. Sangeux M, Passmore E, Gomez G, Balakumar J, Graham HK. Slipped capital femoral epiphysis, fixation by single screw in situ: A kinematic and radiographic study. Clin Biomech. 2014;29(5):523-530. DOI: 10.1016/j.clinbiomech.2014.03.012
  • 13. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49(5):807-835. PMID: 6029256
  • 14. Wensaas A, Gunderson RB, Svenningsen S, Terjesen T. Femoroacetabular impingement after slipped upper femoral epiphysis The radiological diagnosis and clinical outcome at long-term follow-up. J Bone Joint Surg Br. 2012;94(11):1487-1493. DOI: 10.1302/0301-620X.94B11.29569
  • 15. Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E. A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg. Br2007;89(10):1309-1316. DOI: 10.1302/0301-620X.89B10.19405
  • 16. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556-560. DOI: 10.1302/0301-620x.84b4.12014
  • 17. Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(S4):47-66. DOI: 10.2106/JBJS.H.00756
  • 18. Paley D. Normal lower limb alignment and joint orientation. In: Principles of deformity correction. Berlin: Springer-Verlag, 2002:1-19. DOI: 10.1007/s001320050004
  • 19. Bouma H, Slot NJ, Toogood P, Pollard T, van Kampen P, Hogervorst T. Where is the neck? Alpha angle measurement revisited. Acta Orthop. 2014 Apr;85(2):147-51. DOI: 10.3109/17453674.2014.899841.
  • 20. Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19(4):419-424. DOI: 10.1097/00004694-199907000-00001
  • 21. Mamisch TC, Kim YJ, Richolt JA, Millis MB, Kordelle J. Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis Clin Orthop Relat Res. 2009;467(3):692-698. DOI: 10.1007/s11999-008-0477
  • 22. Ng KC, Mantovani G, Lamontagne M, Labrosse MR, Beaulé PE. Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking. Clin Orthop Relat Res. 2017;475(4):998-1008. DOI: 10.1007/s11999-016-5038-2
  • 23. Caskey PM, McMulkin ML, Gordon AB, Posner MA, Baird GO, Tompkins BJ. Gait outcomes of patients with severe slipped capital femoral epiphysis after treatment by flexion-rotation osteotomy. J Pediatr Orthop. 2014;34(7):668-673. DOI: 10.1097/BPO.0000000000000180
  • 24. Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhäuser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):749-756. DOI: 10.1097/00004694-200011000-00010
  • 25. Diab M, Daluvoy S, Snyder BD, Kasser JR. Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B. 2006;15(2):87-92. DOI: 10.1016/j.fcl.2017.10.001

Femur başı epifiz kayması tanılı hastalarda klinik ve radyolojik sonuçların yürüme analizi ile korelasyonu

Year 2020, Volume: 4 Issue: 2, 161 - 168, 12.07.2020
https://doi.org/10.30565/medalanya.694570

Abstract

Amaç: Bu çalışmanın amacı femur başı epifiz kayması (FBEK) nedeniyle opere edilen hastalarda yürüme analizi ile klinik ve radyolojik sonuçların korelasyonunu değerlendirmekti. 

Hastalar ve Yöntem: Bu çalışmaya ortalama takibi 3.3 ± 1.4 yıl olan tek taraflı FBEK tanısıyla opere edilen 31 hasta dahil edildi. Klinik değerlendirme Harris kalça skoru (HKS) ve Pediatrik Veri Toplama Aracı (PVTA) skoru ile yapıldı. Radyolojik değerlendirme için kayma açısı, alpha alçısı, lateral femur başı oranı, artikulotrokanterik mesafe (ATM), ön-arka planda femur başı oranı, anterior baş-boyun offset oranı ve boyun şaft açısı ölçümü yapıldı. Yaş eşleşmeli 20 sağlıklı bireyden kontrol grubu oluşturuldu. 

Bulgular: PVTA transfer ve temel mobilite alt ölçeği; pelvis tilt eklem hareket açıklığı (EHA) (r = −0.7, p <0.001), ayak ilerleme açısı EHA (r =−0.4, p=0.02) ve ortalama omurga tilti (r=−0.6, p<0.001) ile anlamlı korelasyon gösterdi. Ayrıca ayak ilerleme açısı ile HKS (r=−0.5, p<0.001) ve PVTA ağrı/konfor alt ölçeği anlamlı korelasyon gösterdi (r=−0.5, p=0.015). Lateral femur başı oranı ile ortalama kalça fleksiyonu (r=−0.5, p<0.001), pelvik tilti (r=−0.4, p=0.04) ve ortalama omurga tilti (r=0.6, p<0.001) koreleydi. ATM ile ortalama kalça iç rotasyonu (r=0.5, p=0.03) ve ortalama ayak bileği ekstansiyonu (r=−0.4, p=0.03) koreleydi. Alfa açısı, Ön-arka femur başı oranı ve anterior baş boyun ofsetinin kinematik değerlerle korelasyonu gösterilemedi. 

Sonuç: FBEK nedeniyle opere edilen hastalarda klinik skorlar çoğunlukla pelvik tilt EHA, ayak ilerleme açısı ve omurga tilti ile korelasyon gösterirken, radyolojik sonuçlardan lateral femur başı oranı ve ATM’nin yürüme fonksiyonu ile ilişkili olduğu anlaşılmıştır. 

References

  • 1. Krauspe R, Weinstein S. Special symposium issue: slipped capital femoral epiphysis (SCFE). J Child Orthop. 2017;11(2):85-86. DOI: 10.1302/1863-2548-11-170032
  • 2. Cooper AP, Salih S, Geddis C, Foster P, Fernandes JA, Madan SS. The oblique plane deformity in slipped capital femoral epiphysis. J Child Orthop. 2014;8(2): 121-7. DOI: 10.1007/s11832-014-0559-2
  • 3. Lehmann TG, Engesæter I, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. Radiological findings that may indicate a prior silent slipped capital femoral epiphysis in a cohort of 2072 young adults. Bone Joint J. 2013;95B(4):452-8. DOI: 10.1302/0301-620X.95B4.29910
  • 4. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39 Suppl:36S-42S. DOI: 10.1177/0363546511413993
  • 5. Brisson N, Lamontagne M, Kennedy MJ, Beaule PE. The effects of cam femoroacetabular impingement corrective surgery on lower-extremity gait biomechanics. Gait Posture. 2013;37(2):258-63. DOI: 10.1016/j.gaitpost.2012.07.016
  • 6. Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait walking biomechanics of FAI. Gait Posture. 2009;30(1):41-4. DOI: 10.1016/j.gaitpost.2009.02.008
  • 7. Rylander J, Shu B, Favre J, Safran M, Andriacchi T. Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome. J Orthop Res. 2013;3(9):1461-8. DOI: 10.1002/jor.22375
  • 8. Westhoff B, Ruhe K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. The gait function of slipped capital femoral epiphysis in patients after growth arrest and its correlation with the clinical outcome. Int Orthop. 2012;36(5):1031-1038. DOI: 10.1007/s00264-011-1409-1
  • 9. Seller K, Wild A, Westhoff B, Raab P, Krauspe R. Clinical outcome after transfixation of the epiphysis with Kirschner wires in unstable slipped capital femoral epiphysis. Int Orthop. 2006;30(5):342-347. DOI: 10.1007/s00264-006-0110-2 

  • 10. Song KM, Halliday S, Reilly C, Keezel W. Gait abnormalities following slipped capital femoral epiphysis. J Pediatr Orthop 2004;24(2):148-155. PMID: 15076598
  • 11. Westhoff B, Schröder K, Weimann-Stahlschmidt K, Zilkens C, Willers R, Krauspe R. Radiological outcome and gait function of SCFE patients after growth arrest. J Child Orthop. 2013;7(6):507-512. DOI: 10.1007/s11832-013-0528-1
  • 12. Sangeux M, Passmore E, Gomez G, Balakumar J, Graham HK. Slipped capital femoral epiphysis, fixation by single screw in situ: A kinematic and radiographic study. Clin Biomech. 2014;29(5):523-530. DOI: 10.1016/j.clinbiomech.2014.03.012
  • 13. Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49(5):807-835. PMID: 6029256
  • 14. Wensaas A, Gunderson RB, Svenningsen S, Terjesen T. Femoroacetabular impingement after slipped upper femoral epiphysis The radiological diagnosis and clinical outcome at long-term follow-up. J Bone Joint Surg Br. 2012;94(11):1487-1493. DOI: 10.1302/0301-620X.94B11.29569
  • 15. Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E. A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg. Br2007;89(10):1309-1316. DOI: 10.1302/0301-620X.89B10.19405
  • 16. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556-560. DOI: 10.1302/0301-620x.84b4.12014
  • 17. Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(S4):47-66. DOI: 10.2106/JBJS.H.00756
  • 18. Paley D. Normal lower limb alignment and joint orientation. In: Principles of deformity correction. Berlin: Springer-Verlag, 2002:1-19. DOI: 10.1007/s001320050004
  • 19. Bouma H, Slot NJ, Toogood P, Pollard T, van Kampen P, Hogervorst T. Where is the neck? Alpha angle measurement revisited. Acta Orthop. 2014 Apr;85(2):147-51. DOI: 10.3109/17453674.2014.899841.
  • 20. Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19(4):419-424. DOI: 10.1097/00004694-199907000-00001
  • 21. Mamisch TC, Kim YJ, Richolt JA, Millis MB, Kordelle J. Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis Clin Orthop Relat Res. 2009;467(3):692-698. DOI: 10.1007/s11999-008-0477
  • 22. Ng KC, Mantovani G, Lamontagne M, Labrosse MR, Beaulé PE. Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking. Clin Orthop Relat Res. 2017;475(4):998-1008. DOI: 10.1007/s11999-016-5038-2
  • 23. Caskey PM, McMulkin ML, Gordon AB, Posner MA, Baird GO, Tompkins BJ. Gait outcomes of patients with severe slipped capital femoral epiphysis after treatment by flexion-rotation osteotomy. J Pediatr Orthop. 2014;34(7):668-673. DOI: 10.1097/BPO.0000000000000180
  • 24. Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhäuser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):749-756. DOI: 10.1097/00004694-200011000-00010
  • 25. Diab M, Daluvoy S, Snyder BD, Kasser JR. Osteotomy does not improve early outcome after slipped capital femoral epiphysis. J Pediatr Orthop B. 2006;15(2):87-92. DOI: 10.1016/j.fcl.2017.10.001
There are 25 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Hanifi Üçpunar 0000-0001-8394-0708

Kubilay Beng This is me 0000-0001-8196-6605

Sebahat Aydil This is me 0000-0002-7334-9022

Timur Yıldırım 0000-0003-0291-7632

Mehmet Yağmurlu This is me 0000-0001-5782-0390

Avni İlhan Bayhan 0000-0001-8308-1309

Publication Date July 12, 2020
Submission Date February 26, 2020
Acceptance Date April 4, 2020
Published in Issue Year 2020 Volume: 4 Issue: 2

Cite

Vancouver Üçpunar H, Beng K, Aydil S, Yıldırım T, Yağmurlu M, Bayhan Aİ. Correlation of Functional and Radiological Results with Three-Dimensional Gait Analysis in Patients with Unilateral Slipped Capital Femoral Epiphysis. Acta Med. Alanya. 2020;4(2):161-8.

9705

This Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.