Pediatric hip disorders are common and can lead to deleterious outcomes if not recognized or treated in a timely fashion. They can have long-term implications and can potentially lead to end-stage degenerative hip disease. The current issue addresses two of these hip disorders, slipped capital femoral epiphysis (SCFE), which is commonly seen in obese adolescents, and Perthes disease, which is usually encountered during early school years.
With acquisition of new surgical knowledge and skills, the treatment of SCFE continues to evolve. Although in situ fixation and, if needed, subsequent deformity correction continue to be the gold standard of treatment, there is an increasing interest in acute anatomic reduction and stabilization for SCFE. Whether acute repositioning of femoral epiphysis in the setting of unstable SCFE would prevent the disastrous complication of avascular necrosis is still a debatable question. Also, the indications for redirectional osteotomy versus arthroscopic or open treatment of femoroacetabular impingement secondary to residual proximal femoral deformity after healed SCFE continue to be refined. Peck and Herrera-Soto provide a comprehensive review of the current practice and literature to address these controversies related to SCFE.
Perthes disease has baffled surgeons for generations. With limited knowledge pertaining to the etiology of the disease, there is minimal hope to prevent or cure this disease. Treatment and research efforts are rather aimed to prevent the adverse sequelae of the disease. Dr Shah discusses the natural history, prognostic factors, and management of this disease in its active and late stage. Toward the end of the article, Dr Shah discusses the optimal treatment strategies to address adverse sequelae of the disease.