Slipped capital femoral epiphysis associated with renal failure osteodystrophy

A retrospective institutional and literature review of 31 children (20 boys and 11 girls) with 58 renal failure-associated slipped capital femoral epiphyses (RFASCFEs) was performed. The average age at diagnosis of renal failure was 8.9 years, and for RFASCFE 11.5 years, with a linear correlation between these two ages. All patients had secondary hyperparathyroidism at diagnosis of the RFASCFE. The median height and weight were below the 5th percentile. The RFASCFEs were stable and bilateral in 95% of the children. Slip magnitude was mild in 53%, moderate in 8%, and severe in 39%. Avascular necrosis was associated with steroid immunosuppression in children with renal transplants. All children were treated with medical management; surgery was used in an additional 29 hips. If correction of secondary hyperparathyroidism is not achieved within 2 months, RFASCFEs are likely to progress and surgical stabilization is recommended.