Slipped capital femoral epiphysis (SCFE)

Children’s Hospital Boston’s hip sub-specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care. How we’ll treat your child’s SCFE depends on the complexity and severity of his condition—as well as his age, overall health, medical history and the expectations for the course of his condition as he grows.

The goals of treatment are:

• to prevent the femoral head from further slippage and to avoid complications
• to eliminate hip impingement, which is the usual cause of arthritis in those SCFE hips that have later problems
   

In severe cases, surgery also aims to eliminate the deformities that cause hip impingement, which is the usual cause of arthritis in SCFE hips that have later problems.

Treatment can include:

• limited open surgery that uses steel screws and pins (internal fixation) to hold the femoral head onto the femur to stabilize it prevent it from slipping further; this is the standard of care for SCFE
   
• more complex surgical procedures for severe cases
  • can involve cutting and realigning the upper end of the femur (osteotomy) or reshaping the bone (osteochondroplasty)
  • carry some risk of damage to vessels supplying blood to the bone and to the health of the bone itself (avascular necrosis, or bone death
     
• physical therapy following surgery to help strengthen the hip and leg muscles

Care before and after surgery

Before your child’s procedure, he must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until his surgery.

After surgery, your child will need to limit his weight-bearing by using crutches or a walker for about six to eight weeks. Physical therapy will help him restore his muscle strength.
 

Specialist care throughout your child’s growth period

Success rates are high for SCFE treatment at Children’s. Even so, any child who’s been treated for SCFE must still be followed periodically by his orthopedist until his skeletal growth is complete. Your doctor will monitor your child’s repaired hip, since it needs to grow normally through the whole growth period in order to be durable for a lifetime.

The majority of surgical treatments for SCFE at Children’s occur without major complications. But later in life, hip problems can recur, even after successful treatment in childhood. The more severe the case, the greater the chance for limited hip motion, different leg lengths and further hip problems in the future. At Children’s we follow SCFE patients throughout their lives.
 

Coping and support

We at Children’s understand that a hospital visit can be difficult. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with SCFE. Will my child need surgery? How long will his recovery take? Will it affect my child long term? What should we do at home? Children’s can help you connect with extensive resources to help you and your family through this stressful time, including:

• patient education: From doctor’s appointments to treatment to follow-up, our nurses and physical therapists will be on hand to walk you through your child’s diagnosis, surgery and recovery. And once your child is home, we’ll help you coordinate and continue the care and support he received at Children’s.
   
• parent-to-parent: Want to talk with someone whose child has been treated for slipped capital femoral epiphysis? Our Hip Unit can often put you in touch with other families who’ve been through the same experience that you and your child are facing.
   
• faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
   
• social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial issues.
   

Children’s also is:

• the oldest and largest comprehensive center for the care of spina bifida
• one of the first pediatric sports medicine clinics in the nation
• one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma

The Experience Journal

Designed by Children’s psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.