Slipped capital femoral epiphysis (SCFE)

What is a slipped capital femoral epiphysis?

A slipped capital femoral epiphysis (SCFE) or ‘slip’ is a serious hip problem where the ball of the hip falls off the thigh bone in a child, a bit like an ice cream slipping off its cone. It often happens slowly over several months and can be difficult to diagnose. It typically happens in ‘tweenage’ or teenage kids and is linked to obesity and occasionally thyroid disease or growth hormone treatment and rarely kidney disease.

What are the symptoms?

It’s a tricky condition as it can cause hip, thigh or knee pain and it’s quite a common story to have a several month delay before finally getting the correct diagnosis. Often children have a limp and walks with the knee and foot pointing outwards more than the normal side. If the pain suddenly becomes very severe it usually means the slip has suddenly become unstable, which is a much more serious problem as it can affect the blood supply to the ball.

How is it diagnosed?

After talking to you and examining you, we confirm the diagnosis with an X-ray. Sometimes we do bloods tests to rule out other conditions that are linked to SCFE. For very displaced slips and very painful ones we usually get a Perfusion MRI and CT scan before your operation.

What is the treatment for a slipped capital femoral epiphysis (SCFE)?

The treatment is dependent on each individual patient and how severe the slip is. In most cases an operation is performed to stabilise the affected hip using pins to hold the femoral head onto the thighbone. This is called in-situ pinning.

In some cases, the unaffected side may be pinned to prevent slippage in the future.

Open reduction operation

In more severe cases more extensive surgery may be required, known as open reduction, in order to check the blood supply of the ball and put it back in its correct position safely. We have several highly trained surgeons that offer this modern technique. After your surgery you will be admitted to the orthopaedic ward and once you are comfortable and ready the physiotherapy team will see you and help you start to move with crutches.

Why should I have the operation?

The aim of the treatment is to help you have a stable hip joint as you grow, to avoid damage to the blood supply and to reduce the risk of arthritis developing in adult life. Mild deformities can progress if not stabilised early. Avascular necrosis (AVN) also becomes a significant risk. This is where the blood supply becomes limited to the femoral head (top of your thigh bone) which can cause pain and a gradual collapse of the bone.

What happens after the surgery?

In less severe slips treated early, most individuals recover successfully with few problems. You will continue to be followed up in the outpatient clinic throughout your growth to monitor your progress. With more severe cases, pain and stiffness can be a problem. If the blood supply is injured then the hip can sometimes completely fail and become arthritic. We get a special CT scan at 4 weeks post op to check the blood supply of the ball which helps us to decide on whether any further surgeries need to be considered.

Recovery

You will be on crutches for several weeks or months following surgery. You should avoid high impact activities until your consultant says it is safe to return. This helps to minimise the risk of complications and helps the healing process.

Support

If you have any questions or concerns please don’t hesitate to contact the team on the number below.