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Adjudication committee
- 1. opponent: Professor Gunnar Hägglund, Lund University
- 2. opponent: Professor Emeritus Lars Birger Engesæter, University of Bergen
- 3. member of the adjudication committee: Professor Harriet Akre, University of Oslo
Chair of the Defence
Professor Mathias Toft, University of Oslo
Summary
Slipped capital femoral epiphysis (SCFE) is characterized by a displacement of the metaphysis of the upper femur in relation to the epiphysis. 25% of the patients suffer from contralateral SCFE until skeletal maturity, but no reliable method exists to predict subsequent contralateral slip. There is an increased risk of osteoarthritis (OA) later in life after SCFE.
Paper I-IV are based on 66 patients treated for SCFE from 1953 to 1986. The main purpose was to evaluate the long-term outcome after SCFE, to assess the reliability of the radiographic measurements of persistent deformity after SCFE, and to find risk factors for poor outcome. Additionally, we wanted to investigate the natural history of the untreated contralateral hip in primary unilateral SCFE. At follow-up, the patients were examined clinically and radiographically. The outcome was classified as good when the patient had not undergone total hip replacement, had no OA and Harris Hip Score was ≥ 85 points. Mean follow-up time was 38 years (21-57). The long-term outcome after chronic SCFE treated with in situ fixation was good in 69% of the patients. The inter-observer agreement of the radiographic measurements of persistent deformity after SCFE was moderate and worse in hips previously treated for SCFE. Persistently abnormal alfa angles were associated with inferior long-term outcome. 35 of 40 patients with primary unilateral SCFE had good long-term outcome in the untreated contralateral hip and we conclude that routine prophylactic fixation is not indicated.
Paper V is based on 22 patients treated for unilateral SCFE from 2007 to 2010. MRI of both hips was taken before operative fixation. The study concluded that MRI taken at primary diagnosis could not predict later contralateral slip.
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