Acta Orthopaedica - 2026-08-05 - Journal Article
The Swedish experience of capital realignment surgery for slipped capital femoral epiphysis: results from a nationwide retrospective cohort of 28 patients.
Nilsson J, Lindell M, Örtegren J, Herngren B, Stenmarker M, Michno P, Tiderius CJ
Topics
Key Takeaway
Capital realignment for SCFE yielded a 22% overall AVN rate (6/27), with 50% AVN in unstable slips versus 11% in stable slips, and zero AVN in the 8 cases with intraoperative epiphyseal perfusion monitoring.
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Summary
This nationwide Swedish retrospective cohort examined outcomes of capital realignment surgery (predominantly modified Dunn) for SCFE in 28 patients treated 2009–2021. AVN occurred in 6/27 patients (22%): 4/8 unstable (50%) versus 2/19 stable (11%). Median HAGOS and iHOT12 scores were 77 and 76 overall, improving to 91 and 88 when surgery was performed as primary treatment within one month of diagnosis.
Key Limitation
The cohort of 28 patients—accumulated over 12 years across an entire nation—reflects the extreme rarity of this procedure in practice, making all subgroup comparisons (stable vs. unstable, monitored vs. unmonitored) statistically underpowered and susceptible to confounding by surgeon experience and case selection.
Original Abstract
BACKGROUND AND PURPOSE
Optimal treatment for slipped capital femoral epiphysis (SCFE) has been controversial for decades. Capital realignment surgery (predominant technique: modified Dunn) is a technique to restore anatomy, but it is associated with varying risks of avascular necrosis (AVN) of the femoral head. The aim of our study was to describe outcomes following capital realignment for severe SCFE in a nationwide cohort.
METHODS
A longitudinal, nationwide, retrospective cohort study of SCFE patients treated with capital realignment between 2009 and 2021 was conducted, with radiographic and clinical follow-up 2-15 years after surgery. Primary radiographic outcome was AVN. Clinical outcomes were assessed using patient-reported outcome measures (the Copenhagen Hip and Groin Outcome Score [HAGOS] and the 12-item International Hip Outcome Tool [iHOT12]).
RESULTS
28 patients were included but 1 patient declined radiographic follow-up. 6/27 (22%, 95% confidence interval [CI] 11-41), developed
AVN
2/19 patients with stable SCFE and 4/8 patients with unstable SCFE. None of the 8 cases in which epiphyseal perfusion was monitored intraoperatively developed AVN. The median total HAGOS and iHOT12 scores were 77 (CI 56-94) and 76 (CI 72-88), respectively. When capital realignment was performed as primary treatment (< 1 month from diagnosis), the corresponding scores were 91 (CI 70-98) and 88 (CI 73-98).
CONCLUSION
The overall AVN rate was 22%. Our findings suggest that capital realignment should be reserved for stable SCFE and performed as primary treatment, with intraoperative epiphyseal perfusion monitoring.