Clin Orthop Surg.  2019 Dec;11(4):466-473. 10.4055/cios.2019.11.4.466.

Alpha Angle as a Predictor of Impending Contralateral Slipped Capital Femoral Epiphysis in an Asian Population

• Chan CX
• Yang YO
• Cheng GH
• Gera SK
• Mohammad A

• KMID: 2462542
• DOI: http://doi.org/10.4055/cios.2019.11.4.466

Abstract

BACKGROUND
Prophylactic pinning of the uninvolved side after unilateral slipped capital femoral epiphysis (SCFE) is controversial. The alpha angle, a measurement of femoral head-neck aspherity, was proposed as a predictor of progression of contralateral SCFE with a treatment threshold of greater than 50.5°. The aim of this study was to evaluate its validity in our cohort of patients.
METHODS
A retrospective review of a 10-year series of patients who presented with unilateral SCFE was conducted. Minimum follow-up duration to identify contralateral progression was 18 months. Age, sex, ethnicity, and endocrinopathies were noted. Alpha angle measurements of the unaffected hip were performed by two independent observers. The average values of measurements were used for analysis. Univariate and multivariate logistic regression analyses were performed to identify predictors of contralateral progression. A receiver operating characteristic (ROC) curve was generated.
RESULTS
There were 43 patients with unilateral SCFE. Seven patients (16.3%) developed contralateral SCFE. There were 31 males (72.1%) and 12 females (27.9%). The mean duration from index surgery to contralateral fixation was 43.9 weeks (range, 16.2 to 77 weeks). The mean alpha angle was significantly higher in the patients with contralateral progression (mean, 50.7°; standard deviation [SD], 5.4°; range, 43.8° to 58.5°) than in the patients without progression (mean, 43.0°; SD, 4.2°; range, 33.0° to 52.5°; p < 0.001). The alpha angle was also identified as a statistically significant predictor of contralateral progression on multivariate analysis (p = 0.02). The intraclass correlation coefficient for interobserver reliability was moderately strong at 0.76 (95% confidence interval, 0.55 to 0.87). The area under the ROC curve was 0.88. The treatment threshold of 50.5° had a sensitivity of 0.43, specificity of 0.94, and number needed to treat (NNT) of 2.7. The ideal treatment threshold derived from the ROC curve was 49.0°, which had a sensitivity of 0.71, specificity of 0.89, and an NNT of 1.7.
CONCLUSIONS
Alpha angle is a potential predictor of contralateral hip involvement in children with SCFE who may benefit from prophylactic hip fixation. Results from our series suggest a treatment threshold be 49.0°. However, given the limited sample size and moderately strong interobserver reliability, larger studies are needed to validate our findings.

Keyword

Hip; Slipped capital femoral epiphysis; Alpha angle; Bilateral progression

MeSH Terms

Asian Continental Ancestry Group*
Child
Cohort Studies
Female
Follow-Up Studies
Hip
Humans
Logistic Models
Male
Multivariate Analysis
Retrospective Studies
ROC Curve
Sample Size
Sensitivity and Specificity
Slipped Capital Femoral Epiphyses*

Figure

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  Fig. 1 Measurement of the alpha angle.

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  Fig. 2 The receiver operating characteristic (ROC) curve for alpha angle with respect to contralateral progression.

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