What is slipped capital femoral epiphysis?
A good, stable connection at the hip joint is what lets us walk, run, jump, and do many other things. But in some children, the thigh bone and the hip bone are less well connected.
Slipped capital femoral epiphysis (SCFE) is when the relatively soft growth plate in growing adolescents slides away from the top of the thigh bone (femoral head) at the hip. This causes the ball (femoral head) of the hip joint to lose its circular shape. That shape is very important for your leg and hip to move properly.
SCFE causes a weakened hip joint. It can be an issue in just one hip but it often affects both hips eventually. Kids with SCFE often have groin or thigh pain, they can get knee pain, or develop a limp.
SCFE develops over time and often not because of any injury. It is more common in boys than girls, kids ages 10 to 16, and those who are overweight.
When caught early, most cases of SCFE can be treated successfully.
Most common symptoms
It can be unsettling to parents when their child has significant pain in a muscle, bone, or joint without any obvious cause. Conditions such as infections, joint inflammation, and bone tumors can be sources of musculoskeletal pain in a child that comes on gradually and leads to severe pain and difficulty with walking. But the most common hip disorder in adolescents is SCFE (pronounced “skiffy”). —Dr. Benjamin Schwartz
SCFE usually feels like pain in the groin or thigh. It gets noticeably worse over a few days or weeks. People will often have a limp suddenly for no obvious reason. That may be a sign that this illness is in its early stages.
Sometimes, the main complaint is knee pain. That’s because when the nerves around a child’s hip are irritated, they feel it in the knee. The knee itself is actually fine.
Your child might also feel like their thigh is very weak or they may feel like they need crutches to walk or can’t walk at all.
Other symptoms you may have
- Inability to walk with or without crutches
- Thigh weakness
What causes a slipped capital femoral epiphysis?
Stress on the growth plate can cause the very top part of the ball to slip off of its normal position similar to a scoop of ice cream falling partially off of a cone. In more common mild cases (called stable slips), the child is still able to put weight on the leg. In more severe cases (unstable slips), the child is unable to bear weight. —Dr. Schwartz
When children are growing, their body relies on growth plates to create new bone. These areas are fragile. One of these growth plates (called physis) sits in a slanted position between the femur bone and the ball (femoral head) of the “ball and socket” hip joint. It divides the femoral head in half.
All of your weight sits on your hips and on this ball-and-socket joint. Since it’s so fragile, this growth plate can sometimes shear as the body pushes its weight onto the femoral head. The two halves of the femoral head can move a very small distance away from each other. That creates SCFE.
What makes you more likely to have it?
SCFE happens most often to:
- Kids age 10 to 16
- Kids who are overweight (because of the added pressure to the joint)
- African Americans, Pacific Islanders, and Latinos
Certain medical conditions also increase your risk, including:
- Renal disease
- Pituitary disease
- Down syndrome
Is SCFE an emergency?
SCFE is not usually an emergency.
Active children often complain of hip and knee pain. The first step of treatment should be rest, ice, cutting back on activities, and taking over-the-counter anti-inflammatory medication (e.g. ibuprofen).
If the pain or limp gets worse or doesn’t get any better for several days, take your child to the doctor or urgent care. They should get X-rays of their hip and a careful exam.
If your child is unable to walk, with or without crutches, go to an urgent care or ER. This could mean the disease is very far along.
Treatment for slipped capital femoral epiphysis
About 40% of children with SCFE experience a slip in both hips (bilateral) with younger children (10 years or less) at higher risk. —Dr. Schwartz
Your child’s doctor will do a careful physical examination, including watching your child walk. They may also order an X-ray, which will show if the femoral head and growth plate have shifted out of place. After diagnosing SCFE, your doctor may order blood tests. They will likely refer you to an orthopedic surgeon for treatment.
SCFE is treated with surgery to stop the growth plate and femoral head from moving apart. Without surgery, the growth plate will most likely continue to move, which could cause your child to risk losing blood supply to the bone (avascular necrosis), early joint wear (arthritis), and lifelong hip pain.
SCFE surgery is done quickly after diagnosis. It is done under general anesthesia either in a hospital or outpatient surgery center. The orthopaedic surgeon will place one or two metal screws in to anchor the growth plate to the bone where it’s supposed to sit.
Your child will go home with crutches and be given pain medication as needed. They will need to walk with crutches for 6 to 8 weeks. They may need physical therapy to help speed up recovery.
If the SCFE is severe, your surgeon may suggest other options like a hip replacement.
Since the exact cause of SCFE is not known, it’s hard to prevent. But helping your child maintain a healthy weight can help. That will prevent extra pressure on their joints.
If they have one of the known medical disorders that increases their risk for SCFE, their doctor might regularly check their hips, even if they don’t show any symptoms. Once a child’s growth has stopped, they can no longer get SCFE.
If your child has SCFE in one hip, they're very likely to have it in the other eventually. So it's very important to have regular follow-ups with their doctor so they can check the other hip as your child continues to grow.