Is prophylactic fixation preferable to active surveillance of the unaffected contralateral hip in unilateral slipped capital femoral epiphysis?- A Systematic Review

Slipped capital femoral epiphysis is one of the commonest musculoskeletal disorders amongst children. Whilst its management is reasonable well established, the treatment of the unaffected contralateral hip is controversial. The incidence of subsequent contralateral slip has been reported to be between 19 and 63%. The two treatment modalities are prophylactic fixation at initial presentation or active surveillance and fixation on diagnoses of subsequent slip. Both approaches have their merits but there is no clear consensus. Known risk factors include age, sex, young age at initial presentation, endocrine disorders and obesity. Clinical, epidemiological and radiological predictors have been assessed retrospectively but have limited prospective accuracy. We performed a systematic review of the existing literature as per PRISMA guidelines to determine which treatment modality is more effective. Qualitative analysis of the literature also yielded interesting insights into different aspects of the management of the contralateral hip in unilateral SCFE.