Contralateral SCFE

Rate and Risk Factors for Contralateral Slippage in Adolescents Treated for Slipped Capital Femoral Epiphysis: A Comprehensive Analysis  of 3,528 Cases

Introduction: Although the treatment of a slipped capital femoral epiphysis (SCFE) is well defined, the contralateral hip remains at an increased risk for development of subsequent SCFE. Despite this known complication, there is a dearth of literature regarding factors involved in the development of contralateral hip SCFE. The purpose of the study was to report the rate and risk factors for subsequent contralateral SCFE in a large group of adolescents treated for unilateral SCFE.

Methods: A case-control study utilizing aggregated multi-institutional EMR data between January 2003 and March 2023 was conducted. Skeletally immature children diagnosed with SCFE who underwent surgical management were included. An event rate analysis was used to determine the incidence of subsequent contralateral SCFE. Variables associated with contralateral SCFE were identified using adjusted odds ratios.

Results: 15.3% of patients developed contralateral SCFE with a mean of 296.53 (±17.23 SE) days and a median of 190 days following their initial SCFE. Increased thyrotropin (OR=1.43, P=0.036), diabetes mellitus (OR=1.67, P=0.005), severe obesity (OR=1.81, P<0.001), history of Human Growth Hormone (HGH) use (OR=1.85, P<0.001), low vitamin D  (OR=5.75, P<0.001), younger age (boys under 12 years of age (OR=1.85, P<0.001), and girls under 11 years of age (OR=1.47, P=0.026), and tobacco exposure (OR=2.43, P<0.001) were significantly associated with an increased odds of developing contralateral disease.

Conclusion:  In the largest study on this topic, we identified the rate, odds, and risk factors associated with development of contralateral SCFE. We found younger age, hypothyroidism, severe obesity, Vitamin D deficiency, Diabetes Mellitus, and history of HGH use as independent risk factors. Our findings can aid clinical decision making in at-risk patients.