Slipped Capital Femoral Epiphysis

What is slipped capital femoral epiphysis?

Slipped capital femoral epiphysis (also known as SCFE) is a bone disorder that affects the hip joint. The hip joint is a ball and socket joint. The ball part of the joint (epiphysis) is the top of the thigh bone (femur). The bone grows from an area called a growth plate, just below the ball end of the thigh bone. In SCFE, the growth plate slips, which means that the ball and socket don’t line up properly.

This problem is common in teens and is more common in boys than in girls. It is also more common in children who are obese or who are growing rapidly.

How does it occur?

The exact cause is unknown. SCFE usually happens during fast bone growth, such as the start of puberty. Weakness in the growth plate causes it to slip off the rest of the thigh bone.

What are the symptoms?

Common symptoms include:

• weeks or months of either hip or knee pain
• pain on the inside of the knee or groin
• limping
• one leg that looks shorter or is rotated out more than the other leg
• being unable to bear weight (in severe cases)

How is it diagnosed?

Your healthcare provider will watch you walk and check if the hip has full range of motion. The provider will check to see if:

• the hip can turn inward.
• the knee and hip can be lifted toward the chest
• there is extreme pain when the hip is moved

Hip X-rays may also be done.

How is it treated?

It is important to catch and treat SCFE early. Surgery is usually needed. One of 3 surgeries is used depending on the severity of the problem:

• A screw is placed through the thigh bone and into the growth plate to hold it in place.
• Screws are put into the ball of the thigh bone to make the head of the femur stable.
• An abnormal growth plate is removed. Screws are put in to stop further movement of the bone.

After surgery you are placed on crutches for weeks to months. You will have regular appointments with your healthcare provider for the next 18 to 24 months. X-rays are taken to watch the growth plate. Sports and certain activities are restricted until the growth plate closes. Once the growth plate is mature then more intense physical activities are allowed.

What are the main complications?

The main problems that can occur with SCFE are:

• There is a loss of the blood supply to the end of the thigh bone at the hip. This is called avascular necrosis (AVN). AVN leads to destruction of the head of the femur and hip joints.
• There is a loss of cartilage at the hip joint. This may cause a permanent loss of motion of the hip joint.

How can I prevent SCFE?

In many cases SCFE is not preventable. However, many people with SCFE are overweight. The extra weight puts more stress on the growth plate in the thigh bone at the hip. Losing weight may help relieve some of the pressure.