Slipped Capital Femoral Epiphysis – Occurrence, Treatment & Complications

Pre-teens and teenagers are most likely to suffer from the slipped capital femoral epiphysis (SCFE) condition, implying an early-onset of hip osteoarthritis. In SCFE condition, the ball at the head of the thighbone slips in a backward direction from the neck of the bone. 

Early diagnosis and suitable treatment are a must for a patient suffering from SCFE. Further delay could lead to complications such as painful arthritis in the hip joint and/or degeneration of the femoral head, making it difficult for the patient to live normally. The patient experiences stiffness, pain, and instability in the affected hip.

SCFE could begin once the child attains puberty and thereafter, that when the child experiences fast growth. SCFE in boys can occur between 12 – 16 years, while it occurs between 10 and 14 years of age in girls. The incidence of SCFE is more in boys than girls, while some of its reasons could be overweight and family history of SCFE.

If it occurs to children younger or older than the 10 – 16 years age group, they could be suffering from an endocrine or metabolic condition such as hyperthyroidism or hypothyroidism. 

On the other hand, a minor fall or trauma could lead to SCFE condition in the child. Therefore, the onset of Slipped Capital Femoral Epiphysis is gradual. As a result, the affected hip will change its biomechanics, vascularity, and range of motion. 

There are two types of slipped capital femoral epiphysis viz. stable and unstable. A patient with stable slipped capital femoral epiphysis can walk comfortably and bear weight either with or without crutches. On the other hand, a patient with unstable slipped capital femoral epiphysis cannot walk even with crutches. 

Patients with Slipped capital femoral epiphysis complain of instability in the hip, stiffness, and pain, especially in the knee. The affected hip will not be able to bear weight, and the affected leg may appear shorter.

The patients may complain of pain in the hip and the knee, groin, and thigh for weeks or months at varying intervals. The intensity of pain increases after activity leading to an abnormal gait. The affected hip can develop increased external rotation and out-toed gait. 

For the correct diagnosis and treatment, it is essential to determine whether the affected hip and leg can bear weight or not. Usually, SCFE occurs on one side, while its occurrence on the other hip can take place within a year and a half after its initial onset. 

Diagnosis of SCFE 

The orthopedic surgeon will conduct a physical examination of the patient and the general health and medical history. The doctor will check the affected hip and leg for pain, the extent of the range of motions, muscle movement, and spasms. The patient will have to walk while the doctor will check for abnormalities in the walking pattern, including a limp.  

Also, the doctor will suggest x-rays to study the bone structure of the hip, pelvis, and thigh from various angles. If required, an MRI is recommended.

Treatment of SCFE

The orthopedic surgeon will focus on treating the SCFE condition to 

• Prevent the displaced femoral head from slipping further
• Correcting the deformity and preventing further impingement and degeneration of the joint. 
• Maintain the vascularity of the slipped femoral head

After confirming the SCFE condition, the patient should not put any weight on the affected hip and leg. The orthopedic surgeon recommends surgery as soon as possible to correct and stabilize the affected hip.  

Procedures to treat the SCFE condition

In situ fixation – This procedure is performed to treat stable or mild SCFE conditions. The doctor will insert a metal screw across the growth plate so that the position of the femoral head is maintained and to prevent further slippage. The doctor performs this procedure by making a small incision near the hip.  Once the growth plate is closed or fused over time, there is no chance of slippage occurring. 

Open Reduction – This procedure is done on patients with unstable SCFE. It is an extensive procedure with a longer recovery period. In an open reduction procedure, the surgeon will make an open incision in the hip to manipulate the femoral head in its normal position. Then the surgeon will insert a couple of screws to hold the bone in place till the growth plate closes. 

Complications on account of SCFE 

Despite early detection and administration of suitable treatment, the following complications could occur –

• Avascular necrosis (degeneration of the femoral head)
• Chondrolysis (rapid onset of painful arthritis)
• Impingement
• Avascular Necrosis

Severe conditions of SCFE may lead to interruption of blood supply to the femoral head leading to a gradual yet painful collapsing of the bone. This condition is known as avascular necrosis (AVN) or osteonecrosis.

The articular cartilage cover of the bone also collapses, and the bones rub against each other, causing arthritic pain in the joint. The patient could require a Hip reconstruction surgery to restore the hip joint and its mobility. 

Chondrolysis

Chondrolysis is a serious complication of SCFE though it occurs rarely. In this condition, the articular cartilage degenerates rapidly, and the patient complains of pain, deformed hip accompanied by total loss of movement in the affected hip. Inflammation in the hip joint could be one of the reasons for chondrolysis.

Treatment of chondroloysis involves anti-inflammatory medications and physical therapy. In most cases, the recovery is gradual, and reconstructive surgery seems to be the best option for regaining movement in the hip.

Impingment 

Impingement within the hip joint occurs as the screw is placed to stabilize the slipped capital femoral epiphysis. Changes in the shape of the femur and/or socket can lead to femoroacetabular impingement (FAI). To resolve this condition, procedures involving arthroscopy, screw removal, and open reconstruction are performed to relieve the patient from pain on FAI and/or limited mobility in the hip. 

Can SCFE recur?

Over the years, studies have revealed relatively good outcomes for patients with mild or moderate SCFE conditions as there was no need to seek further procedures after their initial treatment.

On the other hand, procedures such as open reduction and internal fixation have been considered on patients who were earlier treated for severe SCFE conditions.