Slipped capital femoral epiphysis in a healed Perthes hip

Abstract

Perthes disease and slipped capital femoral epiphysis (SCFE) in the same child is a rare occurrence. A 7-year-old boy with the left hip Perthes' disease was managed with femur osteotomy. The femur head healed with a spherical congruent hip. After 3 years, he developed right tibia vara which was treated with growth modulation. The deformity was corrected after one and a half years. At age of 15 years, he presented with left side painful limp and typical features of SCFE. The left hip was managed with modified Dunn's osteotomy. The hip range of movements was painless and near-normal range at final follow-up. Though this is the first case of ipsilateral SCFE following healed Perthes in a non-syndromic child, one must always consider SCFE in adolescents with hip or knee pain or altered gait, even if they have had other conditions like Perthes disease in the past.

Keywords: groin pain; orthopaedic and trauma surgery.

Figure 1

Anteroposterior and frog-lateral radiographs of the pelvis with both hip joints showing Modified Elizabethtown Stage Ib Perthes disease of the left hip joint.

Figure 2

Anteroposterior view of pelvis with both hip joints showing left femur head extrusion of 24.56%. Femur head containment could be seen in frog-lateral view.

Figure 3

Left femur head is spherical and hip joint is congruent (Stulberg class II). Mild coxa manga is noted.

Figure 4

Right tibia vara (A) treated with lateral proximal tibial temporary growth modulation (B). The deformity of the proximal tibia got corrected in 1 year 9 months (B–E). The proximal tibia correction achieved was maintained at 3 years from implant removal (F).

Figure 5

Clinical photograph of the child at 15 years of age shows external rotation deformity of the left hip.

Figure 6

Pelvis with both hips radiographs showing left slipped capital femoral epiphysis (Southwick angle difference of 20° in anteroposterior view and 49° in frog-lateral view). The right hip showed coxa-breva, a high trochanter with a neck-shaft angle of 132°. The Southwick angle at the right hip in frog-lateral view was 9°.

Figure 7

MRI of both hips shows left side slipped capital femoral epiphysis with coxa vara and retroversion of the head. The physis of the right side was thin and almost fused. The inclination of physis, the relation of the epiphysis and metaphysis of the right side were maintained.

Figure 8

Follow-up radiographs of the pelvis after safe surgical dislocation and modified Dunn osteotomy of the left femur.