Slipped capital femoral epiphysis fundamentals
Slipped Capital Femoral Epiphysis (SCFE) is a condition of the hip that occurs 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 complications can usually be avoided.
What are the symptoms?
- 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 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 surgery. The most common type of surgery is an 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? Is the surgery safe?
Risks include nerve injury, infection, bleeding, and stiffness.
How does my child prepare for 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 The Cleveland Clinic, call 216.444.0281.
What should I do the night before surgery?
Do not allow your child to eat or drink anything after midnight.
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?
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 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.
How will my child manage at home during recovery from the procedure?
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.
What are the CCF physician credentials?
All doctors at The Cleveland Clinic Department of Orthopaedic Surgery are board-certified or board-eligible in orthopaedic surgery. In addition, our surgeons have subspecialty training and years of experience in pediatric surgery.
All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216.444.2606 or toll free 800.223.2273, ext. 4-2606, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).
What clinical trials and orthopaedic research are being conducted at CCF on the procedure?
Researchers at the Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of The Cleveland Clinic's 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic's personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life.
