What is slipped capital femoral epiphysis (SCFE)?
In SCFE, the head, or "ball," of the thigh bone (the femoral head) slips off the neck of the thigh bone. 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. The foot turns out and the child leans over the affected side when weight is applied to that leg. About a 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. The slipping can result in significant hip deformity leading to joint problems later in life. A more serious concern is tearing of blood vessels that supply nutrition to the portion of the thigh bone that forms the hip joint. The disruption (avascular necrosis or AVN) can lead to significant hip joint deformity and permanent stiffness and pain.
Facts about SCFE:
- It is the most common hip problem in adolescents, but it is rare. Only between two to 10 people in every 100,000 get SCFE.
- This slipping can only happen in children who are still growing, but usually occurs as the child is entering puberty. Children ages 11 to 15 are most at risk.
- Girls are usually affected around the age of 12 and boys impacted around 13.5 years old.
- It is more common in boys than girls and tends to occur in heavy-set children.
- It is more common among African-Americans.
- About one half of cases affect both hips.
- It can range from mild to severe:
- Mild: Up to one-third of the femoral head slips off of the thigh bone.
- Moderate: About one-third to one-half of the femoral head slips off of the thigh bone.
- Severe: More than one-half of the femoral head slips off of the thigh bone.
The cause of SCFE is unknown. Risk factors include:
- Bone problems related to kidney disease
- Medications (such as steroids)
- 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.
- 30% of the time both hips slip at the same time (synchronous slip)
- 70% of the time one hip will slip and then the other hip will slip within about 18 months (asynchronous slip)
We recommend every child has both hips routinely examined. If any symptoms of hip or knee pain appear, especially when associated with the limp, the child should stop walking and be seen immediately by an orthopaedic surgeon. The best treatment for SCFE is to stop the slip before there is distortion of the hip bone.