Slipped Capital Femoral Epiphysis

In slipped capital femoral epiphysis (SCFE), the head, or ball, of the thighbone (the femoral head) slips off the neck of the thighbone. This condition causes the hip joint to become painful and stiff. The slipping can happen very quickly (acute or unstable) from an accident or trauma and lead to significant pain and an inability to walk. It is more likely the slipping will occur slowly (stable or chronic), leading to a limp that may vary in severity over time. Parents may notice their child’s foot turn out and the child leaning over the affected side when weight is applied to that leg. About one-third of the children with a stable or chronic slip complain of knee pain instead of hip pain.

SCFE can cause significant problems for patients in a number of ways, including slipping that may result in a significant hip deformity that leads to joint problems later in life. A more serious concern resulting from SCFE is tearing of blood vessels that supply nutrition to the portion of the thighbone that forms the hip joint. The disruption (avascular necrosis, or AVN) can lead to significant hip joint deformity and permanent stiffness and pain.

Slipping can only happen in children who are still growing but usually occurs when the child is entering puberty, so children ages 11 to 15 are most at risk. Girls are usually affected around 12 years old and boys at about 13 years old. SCFE is more commonly diagnosed in boys than girls and tends to occur in heavy-set children. In addition, research shows that the hip condition is more common among African Americans.

Causes of SCFE are unknown, but risk factors may include:

• Bone problems related to kidney disease
• Chemotherapy
• Medications, such as steroids
• Obesity
• Radiation treatment
• Thyroid problems

It is important to understand that SCFE can occur in either hip. If a child has a slip in one hip, there is approximately a 30% chance that the other hip will slip as well, and approximately 70% of the time, the other hip will slip within about 18 months of the first hip (asynchronous slip).

Our pediatric specialists recommend that every child have both hips routinely examined. If any symptoms of hip or knee pain appear, especially when associated with a limp, your child should stop walking and be seen immediately by a pediatric orthopedic surgeon. The best treatment for SCFE is to stop the slip before there is distortion of the hip bone.

Symptoms of SCFE may resemble other conditions or medical problems of the hip but typically include:

• Pain in the hip that is aggravated by activity
• Pain in the groin, thigh or knee area
• Sudden pain, a limp or feeling like the leg is giving way (acute slip)
• Hip pain and a limp that is relieved by rest (chronic slip)
• Walking with the leg turned outward
• Feeling or hearing a click in the hip

The goal with SCFE is to diagnose the hip condition early to help prevent the head of the femur from slipping further off of the thighbone. Our pediatric specialists recommend:

• A complete medical history and physical examination
• An X-ray
• An MRI

A specialist will also determine the severity of your child’s hip condition:

• Mild: Up to one-third of the femoral head slips off of the thighbone.
• Moderate: About one-third to one-half of the femoral head slips off of the thighbone.
• Severe: More than one-half of the femoral head slips off of the thighbone.

After your child is diagnosed with SCFE, he should stop standing, walking or bearing weight on the hip. He will also need crutches or a wheelchair for a while. The goal is to limit the amount of deformity caused by the slipping and not cause any new problems. The problem must be recognized early on and before any significant slipping occurs, and we recommend treatment begin before the deformity occurs.

We will work with you and your child to create a treatment plan based on:

• Age, overall health and medical history
• The extent of the condition
• Your child’s tolerance for medications, procedures or therapies
• How the condition is likely to affect your child
• Your opinion or preference

Treatment may include:

• Surgery:

• Your doctor may use minimally invasive techniques to make small incisions to stabilize the slipping by placing one or two large screws across the unstable growth plate. Most children are able to leave the hospital the same day and will walk with crutches for four weeks. The screws are made of titanium or stainless steel, completely encased in bone and usually left in place throughout life. Children should not be able to feel the screw, and your child will be able to resume all activities after the hip is healed, including sports. Tell your doctor if pain in the hip or thigh continues.
• For unstable slips, treatment may include repositioning the ball on the end of the femur. Sometimes we use small incisions. Other times, we use surgical dislocation. Our team has unique ways of treating unstable slips. We developed a technique to monitor blood flow to the femoral head. This allows us to reposition the ball on the femur using small incisions and confirming continued blood flow to the ball. This helps minimize the risk of avascular necrosis (bone death) and improves function by repositioning the ball.
• Physical therapy: Following surgery, your child will need to undergo physical therapy to help strengthen the hip and leg muscles. It can help preserve, enhance or restore movement and range of motion for your child’s hip condition.