Abstract
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a unique clinical entity, and many studies in the past few years have attempted to elucidate its natural history and ideal treatment. The modified Dunn procedure is one of its most widely accepted treatment options. However, the development of avascular necrosis (AVN) remains an issue of great concern. The main aim of this study was to identify the relationship between slip stability and the development of AVN after surgical hip dislocation through the modified Dunn procedure. METHODS: A systematic review was conducted according to the PRISMA guidelines. A literature search was performed using the PubMed and Scopus databases with MeSH terms and free text forms. The articles were screened against the preselected criteria, and the ultimately included articles were included in the systematic review. Finally, a meta-analysis was conducted to compare the incidence of AVN between stable and unstable SCFE patients. RESULTS: Based on the inclusion and exclusion criteria, 12 articles were ultimately included in the systematic review, with nine articles eligible for quantitative analysis. Overall, the articles included 532 hips. Only 55 hips developed AVN, with an overall incidence of 10.3%. Among the 55 hips, 18 (32.7%) were stable, and 37 (67.3%) were unstable. Overall, the articles showed a low risk of bias (ROB); however, three articles showed a lack of proper reporting of the patients’ demographics, and one article showed a lack of clear reporting of the clinical information of the study population. The meta-analysis showed that the risk of developing AVN had a cumulative odds ratio (OR) of 0.33 (95% confidence interval 0.11–1.04), with an insignificant effect size of 1.9. (p = 0.06) CONCLUSION: The development of AVN after surgery remains a multifactorial process, and the procedure remains a reliable option for the treatment of both stable and unstable SCFE in the hands of experienced surgeons with an overall low risk of AVN. TRIAL REGISTRATION: The Study is registered on the PROSPERO registry, Study ID: CRD42022374768.