5 Safety

5 Safety

This section describes safety 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.

5.1 Avascular necrosis without chondrolysis was reported in 3% (2/70) of hips with chronic slips and open growth plates, 16% (6/38) of hips with acute‑on‑chronic slips, and 14% (1/7) of hips with chronic slips and fused growth plates, in a case series of 110 patients (115 hips) treated by open reduction without dislocation. In the same study avascular necrosis plus chondrolysis was reported in 1% (1/70) of hips with chronic slips and open growth plates, 8% (3/38) of hips with acute‑on‑chronic slips, and 14% (1/7) of hips with chronic slips and fused growth plates. Chondrolysis alone was reported in 7% (5/70) of hips with chronic slips and open growth plates, 3% (1/38) of hips with acute‑on‑chronic slips, and 43% (3/7) of hips with chronic slips and fused growth plates.

5.2 Avascular necrosis was reported in 26% (7/27) of patients at a mean of 21.4 weeks in a case series of 27 patients treated by open reduction with surgical dislocation.

5.3 Osteoarthritis was reported in 40% (19/48) of hips at mean follow‑up of 16 years in a case series of 65 patients (66 hips) treated by open reduction without dislocation: 19% (9/48) of hips developed grade I osteoarthritis, 6% (3/48) developed grade II osteoarthritis and 15% (7/48) developed grade III osteoarthritis.

5.4 Reoperation, 6 to 8 weeks after surgery, was needed in 8% (3/40) of patients because of breakage of screw or wire fixations in a case series of 40 patients treated by open reduction with dislocation.

5.5 Permanent partial paralysis of the sciatic nerve was reported in 1 patient in the case series of 65 patients (66 hips) treated by open reduction without dislocation.

5.6 Wound infections were reported in 3% (2/66) of hips in the case series of 65 patients (66 hips) treated by open reduction without dislocation.

5.7 Non‑union of the femoral neck was reported in 9% (4/43) of patients in a case series of 43 patients treated by open reduction with dislocation. All patients were treated by revision surgery.

5.8 Heterotrophic ossification was reported in 8% (3/40) of patients in the case series of 40 patients treated by open reduction with dislocation. No further details were provided.

5.9 In addition to safety outcomes reported in the literature, specialist advisers are asked about anecdotal adverse events (events which they have heard about) and about theoretical adverse events (events which they think might possibly occur, even if they have never done so). For this procedure, specialist advisers listed the following anecdotal adverse events: stiffness and fracturing around implants. They considered that the following was a theoretical adverse event: non‑union of the femoral neck.

  • National Institute for Health and Care Excellence (NICE)