The Department of Orthopaedic Surgery

Pediatrics

Patient Guide to Slipped Capital Femoral Epiphysis (SCFE)

What is the Capital Femoral Epiphysis?

The femur is the long bone of the thigh. The end of the femur that connects with the hip consists of a "ball" (also called the "femoral head"). The ball fits inside of a cup that is made up by the pelvic bones and is known as the "acetabulum." During growth, the end of the head is known as the epiphysis and is connected to the rest of the femur by the growth plate (see figure).

Diagram of patient with SCFE on right side of body

What is Slipped Capital Femoral Epiphsysis?

This is a disorder of adolescents in which the growth plate is damaged and the femoral head moves ("slips") with respect to the rest of the femur. The head of the femur stays in the cup of the hip joint ("the acetabulum") while the rest of the femur is shifted.

Radiograph of child with SCFE. Note abnormal
position of the femoral head on the right side
of the body

What causes SCFE?

The exact cause of SCFE is not known. There are many factors, however, that are associated with this condition. In general, they all lead to a weakening of the growth plate (also known as the "physis").

Endocrine disorders (hypothyroidism, panhypopituitarism, hyopogonadism, and renal osteodystrophy) can weaken the physis. Also, obesity and trauma can place significantly more stress on the growth plate and lead to slipping.

The condition is also known to run in families.

What are the signs and symptoms of SCFE?

Patients may have pain in the groin, inner thigh, or knee. They may also not be able to rotate the leg as much. In addition, there may be a change in their gait (i.e. the manner in which they walk) as they try to put as little weight as possible on the affected side. They may also walk with the leg rotated outward.

During the visit to the Pediatric Orthopaedic Surgeon, the adolescent may experience pain when the doctor palpates (i.e. touches) the groin or thigh. He or she might also feel pain when the physician rotates the leg.

What is the treatment of SCFE?

It is very important to prevent the femoral head from slipping any further. This is done by having the child resting in bed. Surgery can then be done. A screw is inserted to connect the femoral head and the rest of femur, thereby closing the growth plate.

Placement of screw in surgical treatment of SCFE
(radiograph)

In severe cases, some surgeons recommend manipulating the hip first to put it back into better positioning before performing surgery. If severe deformities are present, an osteotomy (i.e. breaking the bone and then realigning the bones so that they are in a more correct anatomic position) may be done at a later date. One controversy at this point is whether or not to place a screw in the unaffected hip in order to prevent slippage before it ever occurs. This is generally not done, however, except in cases where the patient is unlikely to follow up with the surgeon or has a metabolic or endocrine disorder which makes slippage in the unaffected hip much more likely.

Are there complications from SCFE or its treatment?

Unfortunately, there are several severe complications that can result from SCFE and its treatment. The first is known as "osteonecrosis." "Osteo" means bone and "necrosis" means death. Basically, the blood supply to femoral head is damaged and the bone dies. This can lead to degenerative joint disease (osteoarthrits). The other complication is called "chondrolysis." "Chondro" means cartilage and "lysis" means "cutting apart." In this complication, the joint cartilage (called articular cartilage) is damaged and leads to a painful and stiff joint.

The major long term complication is called "degenerative joint disease." This is very much like arthritis. The difference, however, is that the cause of arthritis is not known. Some researchers believe that undiagnosed SCFE is actually the number one reason why patients later need total hip replacements in the United States.

What is the prognosis for patients with SCFE?

How a patient will do depends on the severity and the presence of complications (i.e. osteonecrosis and chondrolysis as mentioned above). Even without complications, there is still an increased risk of degenerative joint disease. Losing weight, however, is a major way in which an adolescent can reduce the risk of the later development of dengerative joint disease.

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