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Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis fundamentals

Slipped Capital Femoral Epiphysis (SCFE) is one of the hip conditions that occur in children who are still growing. The epiphysis is the end of a bone that lies between the joint surface and the epiphyseal plate. It is separated from the main shaft of the bone by a soft, flexible layer of cartilage where new bone is formed. In SCFE, the head of the thighbone (femur) slips off the neck of the bone at the growth plate, the weaker area of the bone that has not yet developed. Usually, the leg turns out and the neck of the thighbone moves forward.

The condition, which can occur in one or both hips, develops gradually. Typically, SCFE occurs in overweight children between 11 and 16 years old and is more common among boys. Additionally, it occurs more often among African Americans than Caucasians.

Serious complications can occur as a result of SCFE. Chondrolysis, or rapid destruction of cartilage in the hip joint, is one complication. In addition, and perhaps most dangerous, is the chance that the slipping femoral head will lose its blood supply. In this case, the bone of the hip may die and collapse, resulting in rapid and severe arthritis. Fortunately, with early diagnosis and careful surgical management, these hip complications can usually be avoided.

What are the symptoms of hip conditions?

  • Pain in the groin, knee or thigh
  • Limping
  • Stiffness in the hip
  • Rotated foot
  • One leg may appear shorter than the other

More severe cases of hip conditions are accompanied by extreme pain and the inability to move the affected leg.

What are my child’s treatment options?

To diagnose the condition, your doctor will most likely order X-rays of both hips.

If diagnosed with SCFE, your child will need hip surgery. The most common type of surgery is "in-situ fixation." In this procedure, the surgeon uses a screw to close the growth plate to prevent the thigh bone from slipping. "Pinning" the head of the femur (the epiphysis) in place is necessary to stabilize the growth plate. Typically, the outcomes are excellent with few, if any, complications.

What are the risks of surgery for hip conditions?

Risks include nerve injury, infection, bleeding, and stiffness.

How does my child prepare for hip surgery?

  • Complete any pre-operative tests or lab work prescribed by your child’s doctor.
  • Do not allow your child to take aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your child’s appointment time. If the surgery is being done at Cleveland Clinic, call 216.444.0281.
  • Refrain from eating or drinking anything after midnight the night before surgery.

What does my child need to do the day of surgery?

  • If your child currently takes any medications, have her or him take them the day of the surgery with just a sip of water.
  • Do not allow your child to wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Have your child wear loose-fitting, comfortable clothing.

What happens after surgery for hip conditions?

Ask your surgeon for complete post-operative instructions. Your child will most likely require crutches and can gradually return to sports and other recreational activities.

How long is the recovery period after hip surgery?

Recovery usually takes four to six weeks with a gradual return to normal activity levels.

What is the rehab after surgery?

The need for rehabilitation is evaluated on a patient-by-patient basis. However, most patients do not need rehabilitation after surgery for hip conditions.

How will my child manage at home during recovery from hip surgery?

Your surgeon will provide you with instructions.

How frequently should I schedule follow up appointments with my child’s doctor following surgery?

The first post-operative appointment is usually seven to 10 days after surgery. Your physician will determine the timing of the remainder of your post-operative appointments.

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