Slipped Capital Femoral Epiphysis (SCFE)

What is SCFE?

Slipped capital femoral epiphysis — SCFE — is a condition in which the growth plate at the top of the thigh bone slips out of position. The 'ball' of the hip joint moves backwards relative to the rest of the bone, changing the mechanics of the hip.

It's most common in early adolescence, typically between 10 and 15, and is more common in children who are overweight. It can affect one or both hips.

SCFE is one of the few paediatric orthopaedic conditions that genuinely needs urgent attention. Once the diagnosis is suspected, prompt assessment and treatment are important to prevent further slip and minimise long-term consequences.

What does it feel like?

Symptoms can be acute, gradual, or a mixture of both. Common features include:

• Hip, groin, thigh or knee pain — knee pain is a classic but often misleading presentation

• A limp

• An altered gait, sometimes with the leg turned outwards

• Difficulty bearing weight in more severe cases

• Pain that's been grumbling for weeks or months in some children, or sudden in others

Knee pain in an adolescent without a clear knee diagnosis should prompt assessment of the hips. SCFE is regularly missed because the pain is referred and the hip examination is overlooked.

How is it diagnosed?

Examination typically reveals restricted internal rotation of the hip — a useful clue. The diagnosis is confirmed with imaging.

X-rays of both hips, including a specific view, are the standard. Both hips are imaged because SCFE can be bilateral and the second hip may slip without obvious symptoms. MRI is occasionally used in pre-slip or early cases.

Once the diagnosis is suspected, weight-bearing should be restricted until imaging clarifies the picture — continuing to walk on a slipping hip can make the slip worse.

What are the treatment options?

SCFE is almost always treated surgically, with the goal of stabilising the slip and preventing further movement. The standard procedure involves placing a screw across the growth plate to hold things in position while healing occurs.

In severe slips, more involved surgery may be needed. There's also a long-running discussion about whether to treat the other (apparently normal) hip prophylactically — this is an individual decision based on risk factors. Nev will work through this with you and your child at your consultation.

When should you get it checked?

Seek prompt assessment if:

• Your adolescent has hip, groin, thigh or knee pain without a clear cause

• There's a limp or altered gait

• Your child has been told they have knee pain but it isn't making sense

• There's reluctance to bear weight on one leg

• You're worried something doesn't add up

SCFE is a time-sensitive diagnosis. The earlier it's identified and treated, the better the outcome — and the lower the risk to the other hip in the medium term.