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Slipped Capital Femoral Epiphysis

  • We treat children from birth through childhood, adolescence and young adulthood. Our decades of experience following our patients into adulthood have taught us that kids' hip problems affect them as adults. Our goal is to do everything possible so that the hip will do fine for a lifetime.

    ––Michael B. Millis, MD, professor of orthopedic surgery, Boston Children's Boston

    f your teen or child has been diagnosed with slipped capital femoral epiphysis (SCFE), you’ll have concerns and questions about his treatment, recovery, outlook and other issues. It will comfort you to know that Boston Children's Hospital is a world leader in orthopedic pediatrics. We specialize in innovative, family-centered care that supports the child and family every step of the way.

    About slipped capital femoral epiphysis

    • Slipped capital femoral epiphysis (SCFE) is one of the most common developmental conditions of the hip joint; it usually affects teens and pre-teens.
       
    • In SCFE, a weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone.
       
    • An SCFE is actually a fracture of the growth plate. The fracture is usually a fairly stable one, and the slippage occurs very slowly. Occasionally, the gradual slippage can become very unstable and the ball can completely slip, leading to severe deformity and even blood supply problems to the “ball.” For this reason, every hip with SCFE should be treated immediately to prevent the more immediate dangerous unstable SCFE.
       
    • SCFE can cause pain in the front or side of the hip, though just as often the pain may be felt in the thigh or knee. Often, a child with SCFE may have no pain, but only a limp and an out-toeing gate.
       
    • SCFE is often misdiagnosed as a “groin pull.” It is important to know that children and adolescents almost never get groin pulls, and every hip that seems to have a muscle problem in the groin should be considered as having an SCFE until x-rays prove otherwise.
       
    • A child who’s been diagnosed with SCFE must be seen and treated by an orthopedist as soon as possible. The treatment is a surgical one. He must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until he receives treatment.
       
    • In 20 to 40 percent of cases, SCFE affects both hips. If only one hip is involved at diagnosis, the other hip will slip in an additional 30 to 60 percent of cases.
       
    • Boys are affected more often than girls in a 1.5:1 ratio.
       
    • The mean age of the onset of symptoms for girls is 12 years, for boys, 13.5 years. The age range of onset is usually 12 to 14 years old, but can be earlier.
       
    • SCFE has three degrees of severity:
      • mild: about one-third of the femoral head slips off of the thigh bone
      • moderate: about one-third to one-half of the femoral head slips off of the thigh bone
      • severe: more than one-half of the femoral head slips off of the thigh bon
         
    • The more severe the case, the greater the likelihood that the teen or child will experience limited hip motion, differences in leg lengths, and further hip problems in adulthood.
       
    • With early detection and proper treatment, a positive outcome with few problems is possible.
       
    • At Children's, timely treatment for your child may include surgery and physical therapy to prevent the head of the thighbone from slipping further.
       

    How Boston Children's Hospital approaches slipped capital femoral epiphysis and other developmental hip conditions

    Whatever treatment your child with a hip problem requires, you can have peace of mind knowing that, as national and international orthopedics referral centers, Boston Children’s Child and Adult Hip Preservation Program, and Orthopedic Center have vast experience treating children who every kind of hip condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of SCFE.

    Unique expertise in treating adolescents with hip problems

    Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program, led by Michael Millis, MD, and Young-Jo Kim, MD, PhD, is the only such program of its kind. We offer the extensive experience and the most advanced techniques, with clinicians and researchers who are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Leaders in Bernese periacetabular osteotomy (Bernese PAO)

    At Boston Children's, we’ve performed more than 1,400 Bernese periacetabular osteotomies since 1991 to correct hip dysplasia in teens and adults. Our large volume makes us the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is Boston Children’s standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically from age 13 or 14 through adult).

    One of the first programs

    Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more 5,000 procedures each year. Our program, is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

    The World's Most Extensive Pediatric Hospital Research Enterprise

    Boston Children's is known for our innovative treatments and a research-driven approach. We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient.

    Contact Us

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Right now, you probably have lots of questions: How serious is slipped capital femoral epiphysis? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Boston Children's Hospital can explain your child’s condition fully when you meet with us.

    Background: the normal hip joint

    The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear.

    The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

    What is SCFE?

    Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects teens and, less commonly, kids. In SCFE, the head, or "ball," of the thighbone (referred to as the femoral head) slips off the neck of the thigh bone, much like how a scoop of ice cream can slip off the top of a cone. This condition causes the hip joint to become painful and stiff.

    What causes slipped capital femoral epiphysis?

    In pre-adolescent and adolescent growth and development, a child is growing quickly, as adult hormones begin to circulate in his system. The cartilaginous growth plate (not as strong as bone) gets weaker because it’s broadening. These phenomena, combined with certain anatomical factors, such as the shapes of the femur and the socket, can lead to slippage.

    Risk factors that increase the likelihood of SCFE include:

    • obesity
    • hormonal abnormalities (thyroid, etc.)
    • genetic predisposition (runs in families)
    • medications, such as steroids
    • radiation treatment
    • chemotherapy
    • bone problems related to kidney disease

    What are the signs and symptoms of SCFE?

    Some signs and symptoms can include:

    • pain in the hip that’s aggravated by activity and that may subside with rest
    • pain in the groin, thigh or knee in addition to—or instead of—hip pain
    • walking with a limp, trouble walking, or feeling like the leg is "giving way"
    • walking with a leg turned outward (unilateral slip)
    • walking with a waddle (bilateral slip)
    • inability to sit with knees straight ahead (knees tend to turn outward)

    How common is SCFE?

    SCFE occurs in about 1 per 1,000 to 1 per 10,000 children and teens.

    How serious is SCFE?

    Slipped capital femoral epiphysis (SCFE) is usually an emergency and must be diagnosed and treated early. Treatment is surgical.

    Who’s at risk for developing slipped capital femoral epiphysis?

    • SCFE is an unusual condition which is slightly more likely to occur in boys than girls.
    • Children ages 12 to 14 years are most at risk.
    • SCFE is more prevalent in the northeast region of the United States than in the southwest.
    • It is more prevalent among African-Americans.
    • In many cases, the child is overweight.

    How does a doctor diagnose slipped capital femoral epiphysis?

    In addition to a complete medical history and physical examination, diagnostic procedures for SCFE may include:

    How does Boston Children’s treat SCFE?

    Specific treatment for SCFE is determined by your child’s doctor based on:

    • his age, overall health, and medical history
    • the extent and severity of the slip
    • expectations for the course of the condition

    The goals of treatment are the following:

    • prevent the femoral head from further slippage
    • eliminate any hip impingement (abnormal jamming of the hip when it’s flexed)

    Treatment usually includes:

    • surgery (involving the use of a steel screw or pin to hold the femoral head onto the femur to prevent it from slipping further)
    • physical therapy (following surgery, to help strengthen the hip and leg muscles)

    My child’s SCFE is mild. Does he still need treatment?

    If a child who has a mild case of SCFE remains relatively pain-free, parents may sometimes be tempted to leave their child’s diagnosed condition untreated. First, untreated slips almost always worsen with time—and unpredictably, the ball may completely slip off. But even if the child grows to adolescence without developing serious pain or a noticeable limp, it’s inevitable that his untreated hip will wear out and become arthritic in adulthood. Parents need to understand that sometimes SCFE treatment in childhood is prophylactic (preventive)—to prevent osteoarthritis or other hip problems later on.

    Will my child be OK?

    The majority of children treated for SCFE at Boston Children’s have corrections that enable them to walk, play, grow and live active lives. Diagnosing and treating your child’s SCFE early in its development greatly increases the likelihood of a successful outcome.

    However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he’s fully grown. Also, the more severe the case, the greater the chance for his hip motion to become limited, his legs to grow to different lengths and for him to have further hip problems in the future.

    Unique Expertise in Problems of the Adolescent Hip

    Many teens and young adults with hip problems need diagnostic and surgical techniques that are significantly different from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program, led by Michael Millis, MD, and Young-Jo Kim, MD, is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.

    What new research is Boston Children’s doing regarding developmental hip conditions?

    Developmental hip conditions such as slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

    The clinical and basic science researchers at Boston Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.

    FAQ


    Q: What is SCFE?
    A:
    Slipped capital femoral epiphysis (SCFE) is a condition of the hip joint that affects teens and children. A weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate.
     

    Q: If my child has SCFE, will he be OK?
    A:
    The majority of children treated for SCFE at Boston Children’s have corrections that enable them to walk, play, grow and live active lives. Treating your child’s SCFE as soon as symptoms develop greatly increases the likelihood of a successful outcome.

    However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he’s fully grown. Also, the more severe the case, the greater the chance for his hip motion to become limited, his legs to grow to different lengths and for him to have further hip problems in the future.


    Q: What are the signs and symptoms of SCFE?
    A:
    Some signs and symptoms can include:

    • pain in the hip that’s aggravated by activity and that may subside with rest
    • pain in the groin, thigh or knee in addition to—or instead of—hip pain
    • walking with a limp, trouble walking, or feeling like the leg is "giving way"
    • walking with a leg turned outward (unilateral slip)
    • walking with a waddle (bilateral slip)
    • inability to sit with knees straight (knees tend to turn inward)
       

    Q: How does Boston Children’s treat SCFE?
    A:
    The goal of treatment is to prevent the femoral head from further slippage. Treatment usually includes:

    • surgery (involving the use of a steel screw or pin to hold the femoral head onto the femur to prevent it from slipping further)
    • physical therapy (following surgery, to help strengthen the hip and leg muscles)
       

    Q: If my child has SCFE, what should I ask my Boston Children’s doctor?
    A:
    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child really need treatment for this? What treatment options are there?
    • Will SCFE permanently affect his growth plate and the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • How long should my child be followed by his care team?
    • What can we do at home?
       

    Q: How is SCFE usually diagnosed?
    A:
    Besides a complete medical history and physical exam, tests for SCFE may include:

    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
    • MRI (magnetic resonance imaging), bone scan, blood tests (rarely needed)
       

    Q: If my child has SCFE in one hip, will he develop it in the other hip, too?
    A:
    In 20 to 40 percent of affected children, SCFE will be present in both hips at the time the child is diagnosed. If only one hip is affected, the other hip will eventually slip 30 to 60 percent of the time.
     

    Q: What are the causes and risk factors for SCFE?
    A:
    SCFE is a fracture in growth plates that become weakened as children grow into adolescence through a combination of factors. Risk factors that increase the likelihood of SCFE include:

    • obesity
    • hormonal problems (thyroid, etc.)
    • genetic predisposition (tends to run in families)
    • medications, such as steroids
    • radiation treatment
    • chemotherapy
    • bone problems related to kidney disease
       

    Q: What’s the long-term outlook for a child who has SCFE?
    A:
    Treating your child’s hip as soon as symptoms develop greatly increases the likelihood of a successful outcome. The majority of children treated for SCFE at Boston Children’s have treatments that enable them walk, play, grow and live active lives.

    However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist at least until he’s fully grown. Also, the more severe the case, the greater the chance for limited hip motion, different leg lengths and further hip problems in the future.
     

    Q: What is Boston Children’s experience treating hip problems in children and teens?
    A:
    At Boston Children’s, we’re known for our clinical innovations, breakthrough research and leadership in treatment for SCFE and other hip problems. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Boston Children’s own researchers and clinicians.

    Adolescents and young adults with hip problems usually need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.
     

    Causes

    A weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate. Risks for developing the condition include:

    • obesity
    • hormonal problems (thyroid, etc.)
    • genetic predisposition (tends to run in families)
    • medications, such as steroids
    • radiation treatment
    • chemotherapy
    • bone problems related to kidney disease
       

    Signs and symptoms

    Some signs and symptoms of SCFE can include:

    • pain in the hip that’s aggravated by activity and that may subside with rest
    • pain in the groin, thigh or knee in addition to—or instead of—hip pain
    • walking with a limp, trouble walking, or feeling like the leg is "giving way"
    • walking with a leg turned outward (unilateral slip)
    • walking with a waddle (bilateral slip)
    • inability to sit with knees straight (knees tend to turn inward)
       

    When to seek medical advice

    Contact your child’s doctor is he:

    • has pain in the hip that’s aggravated by activity and that may subside with rest
    • has pain in the groin, thigh or knee in addition to—or instead of—hip pain
    • is walking with a limp, is having trouble walking, or feels as if his leg is "giving way"
    • walks with a leg turned outward (unilateral slip)
    • walks with a waddle (bilateral slip)
       

    Questions to ask your doctor

    If your baby or child is diagnosed with SCFE, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns get addressed.

    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child really need treatment for this? What treatment options are there?
    • Will SCFE permanently affect his growth plate and the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • What can we do at home?
       

    Who’s at risk

    Risk factors that increase the likelihood of SCFE include:

    • obesity
    • hormonal problems (thyroid, etc.)
    • genetic predisposition (tends to run in families)
    • medications, such as steroids
    • radiation treatment
    • chemotherapy
    • bone problems related to kidney disease
       

    Complications

    The majority of surgical treatments of SCFE at Boston Children’s occur without major complications. But if left untreated, the condition will eventually become painful, and osteoarthritis (OA) and its attendant problems may result.

    Severe cases of SCFE require complex surgeries that involve some risk to the femur’s blood supply and bone health. In rare cases, damage to blood vessels can result in osteonecrosis, or bone death.

    Later in life, hip problems can recur, even after successful treatment during childhood. For example, femoral acetabular impingement (FAI) is a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip). FAI is a research topic that Boston Children’s is working on extensively.
     

    Long-term outlook

    Boston Children’s extensive research into bone problems means that we can provide your child with the most innovative care available. As a result, the majority of children treated for SCFE at Boston Children’s have corrections that enable them to walk, play, grow and live active lives.

    However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, your child should continue to be followed by his orthopedist until he is fully grown. Also, the more severe the case, the greater the chance for limited hip motion, different leg lengths and further hip problems in the future.
     

    For teens

    If you’re a teen with a developmental hip problem, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you may also be dealing with pain; medical appointments and procedures; and limiting some of your activities for a period of time.

    If you’re usually an active person, to be experiencing pain or sitting on the sidelines for a while can be depressing and frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help you. And remember that Boston Children’s Child and Adult Hip Preservation Program is always here for you, too.

    Boston Children's Teen Advisory Committee

    To help teenagers take a more proactive role in their treatment and to have their needs recognized, Children’s developed the Teen Advisory Committee. The group—made up of current Children’s patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs, ensure their voices are heard and advocate for change.

    Slipped capital femoral epiphysis glossary

    • acetabulum: hip socket; a part of the pelvis 
    • arthritis (osteoarthritis): joint inflammation, resulting in pain, swelling, stiffness and limited movement. Arthritis can occur when a joint’s cushioning cartilage wears away. 
    • avascular necrosis (osteonecrosis): a condition in which poor blood supply to a bone leads to bone death; the head of the femur is a common site of this condition 
    • The Center for Families at Boston Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care 
    • cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move easily without pain 
    • developmental dysplasia of the hip (DDH, hip dysplasia): a spectrum of hip abnormality—ranging from a minor laxity of the ligament that holds the ball in the socket to a complete dislocation, in which the ball is entirely out of the socket. 
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation 
    • epiphysis: a secondary bone-forming center at the head (ball) of the femur 
    • femoral acetabular impingement (FAI): a “bump” on the neck of the femur that permanently remains as a result of SCFE. The impingement can be small (causing no additional damage) or larger (creating cumulative damage to the cartilage inside the hip). 
    • femoral head: round-headed top of the thigh bone (femur) 
    • femur: the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral head) joins the hip socket (acetabulum) to form the hip joint. 
    • MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body 
    • onset (of signs or symptoms): the first appearance of signs or symptoms 
    • open reduction surgery: a procedure in which the doctor repositions the hip bone into the socket through an incision into the patient’s body 
    • orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the skeletal system, spine and associated muscles, joints and ligaments 
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments 
    • osteonecrosis (avascular necrosis): the death of a bone due to loss of blood supply 
    • osteotomy: a surgical procedure that involves cutting a bone 
    • physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities 
    • physis: growth plate at the ends of bones 
    • slipped capital femoral epiphysis (SCFE): a hip joint condition in whicha weakness of the growth plate (physis) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone. SCFE is actually a fracture of the growth plate. 
    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; to diagnose SCFE, front and side views are usually needed, as well as views of the opposite knee

    Our Complete Orthopedic Team

    Boston Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic center in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians.

  • At Boston Children's Hospital, we know that the first step to treating your child’s slipped capital femoral epiphysis is to form a complete and accurate diagnosis.

    Our goal is to diagnose SCFE early in order to prevent the head of the thigh bone from slipping further, and thus preventing hip deformity. If your child receives a diagnosis of SCFE, he must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until he receives treatment.

    Your child’s doctor will conduct a physical exam, during which he or she can often feel the ball popping in and out of the socket. The doctor will also take a family history (including any hip problems in your family) and may use diagnostic tests to get detailed images of your child’s hip joint.

    In addition to a complete medical history and physical examination, diagnostic procedures for SCFE may include:

    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; to diagnose SCFE, front and side views are usually needed, as well as views of the opposite knee.
       
    • MRI (magnetic resonance imaging), bone scan, blood tests (rarely needed)
  • Boston Children's Hospital 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 Boston 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 Boston 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 Boston Children’s we follow SCFE patients throughout their lives.

    Coping and support

    We at Boston 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 Boston 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? Boston 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 Boston 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 Boston 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.

    A Long Line of Orthopedic Firsts

    With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Boston Children’s is home to many orthopedic breakthroughs, including:

    • a hip program that has performed more than 1,400 Bernese periacetabular osteotomies
    • one of the first scoliosis clinics in the nation
    • advances in our Spinal Program, such as video-assisted thorascopic surgery
    • advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity
    Boston 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 Boston 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.

  • For more than a century, orthopedic surgeons and investigators at Boston Children's Hospital have played a vital role in advancing the field of musculoskeletal research. We’ve developed breakthrough treatments and major advances for conditions such as developmental hip problems, scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

    Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.

    In Boston Children’s Orthopedic Center and Child and Adult Hip Preservation Program, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:

    • full-time basic scientists
    • 28 clinical investigators
    • a team of research coordinators and statisticians
       

    Studies of developmental hip conditions

    Developmental hip conditions such as slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resultant pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

    Boston Children's Hip Program's Unique Insight and Expertise

    Boston Children’s Child and Adult Hip Preservation Program enjoys a special degree of effectiveness—not just because of our long tradition of excellence in pediatric hip care, but also because we follow our patients through adulthood. This gives us a unique perspective, insight and expertise—we can track how the hip works, how the problems evolve, and how the hip’s function changes over time in adult patients who’ve had treatment in childhood. 

    Current and recent studies include the following:

    • We’re conducting a large number of ongoing studies to follow patients who’ve had various treatments for SCFE and hip dysplasia. Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.
       

    For example, a very common hip condition called femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a frequent cause of osteoarthritis of the hip. FAI is a jamming that occurs in some hips, resulting in damage to the cartilage. The most common cause of FAI is a “bump” on the neck of the femur that remains as a result of SCFE. The impingement can be small (causing minor damage) or larger (creating cumulative damage to the cartilage inside the hip and resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.
     

    • We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct hip dysplasia in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.

      PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically teens ages 13 or 14 through adults—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.

      We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
       
    • We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage.
       
    • We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in people with developmental dysplasia of the hip.
       
    • Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. The group now comprises 10 centers in the United States and one in Europe, and enrolls more than 500 patients each year in various studies.
       

    Orthopedic basic science laboratories

    Working in Boston Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

    Children Speak About What it's Like to be a Medical Research Subject

    View a video of a day in the life of Boston Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

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