The evidence on efficacy of open reduction of slipped capital femoral epiphysis is adequate. With regard to safety, there is a risk of avascular necrosis. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake open reduction of slipped capital femoral epiphysis should take the following actions:
Inform the clinical governance leads in their NHS trusts. Specifically, local governance arrangements should ensure that the procedure is done only by clinicians with appropriate training and experience.
Ensure that patients and their parents or carers understand the potential outcomes of having or not having the procedure, in particular the risk of avascular necrosis and its consequences. In addition, the use of NICE's information for the public is recommended.
Clinicians should enter details about all patients having open reduction of slipped capital femoral epiphysis onto the British Society for Children's Orthopaedic Surgery register. Clinical outcomes should also be reviewed locally.
Training and experience are important in preserving the blood supply to the femoral head. When the procedure is done with surgical dislocation of the hip, clinicians should undertake their initial procedures with an experienced mentor.
Patient selection may be complex and specialists should consider, discuss with clinical colleagues, and record the balance between the potential benefits and risks of this procedure for each patient.
Further research into open reduction of slipped capital femoral epiphysis should clearly describe details of clinical presentation (for example, Loder classification), the degree of slip, its stability, and the surgical technique used; including whether surgical dislocation of the hip was done. Outcomes from 2 years onwards should include degree of correction, occurrence of avascular necrosis and need for subsequent hip surgery (and its timing).