4 Efficacy

4 Efficacy

This section describes efficacy outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview.

4.1 In a case series of 64 patients treated by open reduction without dislocation, the mean Iowa Hip Score (scores range from 0 to 100 with higher scores indicating better outcomes) was 94.5 at mean follow‑up of 4.9 years.

4.2 In a case series of 28 patients treated by open reduction with dislocation, mean improvements in Hip disability and Osteoarthritis Outcome Scores (ranging from 0 to 100 with higher scores indicating better outcomes) for pain, other symptoms, activities of daily living and quality of life were 78.6, 78.0, 78.5 and 74.8 respectively, for patients with unstable slips at mean follow‑up of 38.6 months (p values <0.001). In patients with stable slips, mean improvements in Hip disability and Osteoarthritis Outcome Scores for pain, other symptoms, activities of daily living, sports and quality of life were 45.7, 48.6, 40.9, 58.1 and 51.4 respectively (p values <0.001).

4.3 In a case series of 110 patients (115 hips) treated by open reduction without dislocation, 'good' results for subjective, clinical and radiological outcomes were reported in 89% (62/70), 84% (59/70) and 71% (50/70) of hips respectively, in hips with chronic slips and open growth plates at mean follow‑up of 12 years and 11 months. In the same study, 'good' results for subjective, clinical and radiological outcomes were reported in 74% (28/38), 71% (27/38) and 55% (21/38) of hips respectively, in hips with acute‑on‑chronic slips at mean follow‑up of 12 years and 11 months. In hips with chronic slips and partially fused growth plates, 'good' subjective, clinical and radiological results were reported in 29% (2/7), 14% (1/7) and 14.3% (1/7) of hips respectively.

4.4 In a case series of 65 patients (66 hips) treated by open reduction without dislocation, 46% (22/48) of patients had equal leg lengths at minimum follow‑up of 10 years.

4.5 In a case series of 23 patients treated by open reduction with dislocation, the mean preoperative slip angle was 47.6° whereas the mean postoperative slip angle was 4.6 (p<0.0001). In the same study the mean degrees of flexion were 107.3° in treated hips and 114.8° in contralateral hips that were prophylactically pinned, at mean follow‑up of 29 months (p value not significant). The mean degrees of internal rotation in treated hips and contralateral hips were 37.8° and 35.6° respectively at mean follow‑up of 29 months (p value not significant).

4.6 Specialist advisers listed key efficacy outcomes as gait parameters, pain scores, Pediatric Outcomes Data Collection Instrument scores, non‑arthritic hip scores, satisfactory radiological features (Stulberg I/II), incidence of salvage procedures, prevention of secondary arthritis, and a lack of leg length discrepancies.

  • National Institute for Health and Care Excellence (NICE)