Slipped capital femoral epiphysis (SCFE) is a hip disorder. The head of the femur slips off the neck of the bone at the growth plate. Typically, SCFE occurs in overweight children between 11 and 16 years old. Symptoms of SCFE include pain in your teen’s groin, knee or hip; walking with a limp and inability to bear weight on the leg. Surgery is needed.
Slipped capital femoral epiphysis (SCFE) is a disorder of the hip that can happen in your pre-teen or teen. SCFE happens when the head (“ball” part) of the top of the thigh bone (femur) slips backward and downward at the point of growth plate.
The growth plate is where new bone forms. It’s located in the ‘neck’ area of the femur between the “ball” section and the long shaft section of the femur. The growth plate is made up of cartilage, which is a soft, flexible layer. It’s a weaker area than the rest of the bone during the adolescent years when there’s rapid bone growth. When the head of the femur slips, it changes the normal alignment of these sections of the bone.
SCFE can occur in one or both of your child’s hips and develops gradually. It can also occur suddenly due to a fall or other injury.
There are two types of SCFE, stable and unstable.
Typically, SCFE occurs in overweight children between 11 and 16 years old and is more common in boys than girls. SCFE occurs more frequently in African Americans and Hispanic children than Caucasians. It is also more likely to occur in children going through rapid growth spurts.
SCFE is the most common hip disorder in adolescents. It occurs in 11 per 100,000 pre-teens/teens.
The exact cause of slipped capital femoral epiphysis (SCFE) is not known. However, researchers have identified certain factors or associations that increase the risk of developing SCFE. These include:
Symptoms of slipped capital femoral epiphysis include:
Symptoms can be present for a couple weeks up to four or five months before a diagnosis is made.
SCFE is diagnosed through physical exam including rotation of the affected leg, observation while walking and X-rays. A MRI may be ordered if the diagnosis is not able to be made with X-rays and your healthcare provider still suspects your child has SCFE. Your provider may also order blood work to check for other medical conditions.
Surgery is needed. The goal of surgery is to prevent further slippage and avoid complications. The most common type of surgery is called ‘screw fixation.’ In this procedure, the surgeon passes a screw from the side of the top of the femur, through the neck of the femur, through the growth plate and into the ‘ball’ section of the femur. The screw keeps the ‘ball’ section of the femur from slipping out of place.
Surgery is performed as soon as possible because the condition can continue to worsen. If there is a waiting time until surgery, your teen should rest and keep weight off their affected leg as much as possible by using crutches, a walker or wheelchair. Your provider will also prescribe appropriate pain relief medication.
Major complications are avascular necrosis and chondrolysis. Avascular necrosis is a serious complication that happens if your teen’s femoral head has severely slipped. When this happens, the blood supply to the head of the femur is cut off and the hip begins to collapse. This results in rapid and severe osteoarthritis. Reconstructive hip surgery is often needed. Chondrolysis is a condition that happens when there is a sudden and severe destruction of cartilage in the hip joint.
Other complications include the femur growth stops before it normally should, development of SCFE in the other hip and early development of osteoarthritis of the hip.
Your healthcare provider will discuss your child’s expected time to full recovery. It’s unique to each child and depends on many factors including severity of SCFE and type of surgical procedure done. In general, expect that your child will need crutches or a walker for up to about four weeks after surgery for stable SCFE and for at least six to eight weeks for unstable SCFE. Your child will work with a physical therapist to help strengthen leg and hip muscles and improve range of motion. Talk with your provider about when your child can return to normal activities including sports.
The outlook for your teen with slipped capital femoral epiphysis depends on the cause and the severity of the slip. All teens are at increased risk of developing osteoarthritis (regardless of the degree of slip). At some point, reconstructive hip surgery may be needed if symptoms – including hip pain, decrease in range of motion, and stiffness – continue to worsen over time.
Last reviewed by a Cleveland Clinic medical professional on 03/19/2021.
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