Slipped capital femoral epiphysis screw removal

Slipped capital femoral epiphysis screw removal: complications and survey of
attitudes of adult hip surgeons
Oburu E., Macdonald D., Wilson N.I.L., Royal Hospital for Sick Children, Yorkhill,
Glasgow, Scotland
We have reviewed the complication rate over a ten year period for removal of screws placed
for slipped capital femoral epiphysis (SCFE) and have surveyed the views of orthopaedic
surgeons with an adult hip practice in Scotland on leaving the metalwork in situ. Whilst screw
removal is favoured by many orthopaedic surgeons, a recent review of the literature reported
that the complication rate for removal of implants placed for SCFE was 34%.
Between 1998 and 2007 84 patients had insertion of screws for SCFE. Of these 54 patients had
screws removed, 51 of these records were available. The median duration between insertion and
removal of screws was 2 yrs 7 months. Of the 51 children, overall five (9.8%) had
complications – three (5.9%) major and two (3.9%) minor. Two screws could not be removed;
one patient sustained a fracture after screw removal and two developed an infection.
We assessed the attitudes of adult hip surgeons on this topic using an electronic questionnaire
which was completed by 29 out of 40 recipients. 78.6% of respondents support routine
removal and 21.4% favour leaving the screw permanently in place. 82.2% had needed to
remove metalwork from a hip requiring arthroplasty in a patient whose metalwork was
inserted during childhood; and described their experience of this including the complications
We have identified a lower complication rate following screw removal inserted for SCFE than
in published series. Most adult hip suonce the physis is closed but studies regarding the longterm outcome of retained orthopaedic implants are needed since even with this lower
complication rate the question of routine removal remains unclear.