Magnetic resonance imaging at primary diagnosis cannot predict subsequent contralateral slip in slipped capital femoral epiphysis.

Abstract

Prophylactic fixation of the contralateral hip in slipped capital femoral epiphysis (SCFE) is controversial, and no reliable method has been established to predict subsequent contralateral slip. The main purpose of this study was to evaluate if magnetic resonance imaging (MRI) performed at primary diagnosis could predict future contralateral slip. Twenty-two patients with unilateral SCFE were included, all had MRI of both hips taken before operative fixation. Six different parameters were measured on the MRI: the MRI slip angle, the greatest focal widening of the physis, the global widening of the physis measured at three locations (the midpoint of the physis and 1 cm lateral and medial to the midpoint), periphyseal (epiphyseal and metaphyseal) bone marrow edema, the presence of pathological joint effusion, and the amount of joint effusion measured from the lateral edge of the greater trochanter. Mean follow-up was 33 months (range, 16-63 months). Six patients were treated for contralateral slip during the follow-up time and a comparison of the MRI parameters of the contralateral hip in these six patients and in the 16 patients that remained unilateral was done to see if subsequent contralateral slip was possible to predict at primary diagnosis. All MRI parameters were significantly altered in hips with established SCFE compared with the contralateral hips. However, none of the MRI parameters showed any significant difference between patients who had a subsequent contralateral slip and those that remained unilateral. MRI taken at primary diagnosis could not predict future contralateral slip.