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Impact of Obesity on Complication Rates After Treatment of Slipped Capital Femoral Epiphysis: A Retrospective Cohort

Holden Archer¹, Scott B Rosenfeld¹, Pablo Castañeda¹

¹Pediatric Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.

Journal of the Pediatric Orthopaedic Society of North America

|May 4, 2026

Abstract

Background:

While obesity is a well-established risk factor for slipped capital femoral epiphysis (SCFE), limited data exist regarding its impact on postoperative complication rates. This study aimed to evaluate the association between obesity and complications following SCFE treatment.

Methods:

We queried a large national database for pediatric patients who underwent treatment for SCFE between June 2005 and June 2025. We divided this cohort into patients with obesity and patients without obesity. We matched the cohorts with a propensity scoring algorithm on a one-to-one basis, resulting in 1,175 patients in each group. We tracked outcomes including infection, pulmonary embolism (PE), chondrolysis, avascular necrosis (AVN), leg length discrepancy (LLD), and hardware complications. We used the relative risk ratio (RR) and 95% confidence intervals (CIs). P values less than 0.05 were considered significant.

Results:

≤10 (0.85%) patients developed an infection, and none developed a PE; ≤10 (0.85%) patients in each group developed chondrolysis. Thirty-eight (3.23%) patients in the obese group developed AVN after SCFE treatment, and 34 (2.89%) patients in the nonobese group developed AVN (RR = 1.12, CI: 0.71-1.76, P = .632). Seventy-seven (6.55%) patients in the obese group developed LLD compared to 50 (4.26%) patients in the nonobese group (RR = 1.54, CI: 1.09-2.18, P = .014). Sixty-one (5.19%) patients in the obese group had hardware complications, whereas 35 (2.98%) patients in the nonobese group had hardware complications (RR = 1.74, CI: 1.16-2.62, P = .007).

Conclusions:

Patients with obesity had increased rates of LLD and hardware complications after treatment for SCFE compared to nonobese patients. Our findings highlight the importance of ongoing follow-up and monitoring of SCFE patients to detect the development of any of these outcomes.

Key Concepts:

(1)Rates of infection, pulmonary embolism, and chondrolysis were low (<1%) and did not differ between obese and nonobese cohorts.(2)The rate of avascular necrosis was similar between groups.(3)In contrast, obese patients had significantly higher rates of leg length discrepancy and hardware complications.

Level Of Evidence:

III: Retrospective cohort study.

Keywords:

Avascular necrosis Complications Obesity Slipped capital femoral epiphysis

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