Ten-year-old Katie Brennan has always been active. She participates in several sports throughout the year, including soccer and cross country, and skis most winters. But during soccer season last fall, she began to develop a bit of a limp, complaining of pain in her knee.
Her pediatrician initially diagnosed Katie with Osgood-Schlatter disease, an overuse injury of the knee that causes pain and swelling in the area over the shin bone. She underwent physical therapy for her knee and was soon back in action, hitting the slopes with her family that winter.
But that spring, during cross country season, Katie fell during one of her races and could no longer walk. X-rays revealed that it wasn't her knee that was causing the problem; it was actually her hip. Katie had a slipped capital femoral epiphysis—the upper end of her femur (thigh bone) had slipped at the area where the bone grows (growth plate) and wasn't fitting together correctly.
"The doctors told us that Katie was in danger of losing the head of her femur," says her father, William, who is a psychiatrist in Maine. "One of my colleagues said we should take her to Children's Hospital Boston."
Slipped Capital Femoral Epiphysis
Symptoms usually begin between 8 and 16 years of age, but may begin earlier in girls. Symptoms vary in severity and speed of progression and may include:
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Hip pain and decreased movement during the early stages of the condition
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Mild discomfort in the groin, thigh, or knee while walking or running. Rest relieves this discomfort
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Knee pain
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Stiffness, a limp and a walk with the foot turned out
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Muscle spasms in the legs
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Katie was seen by Young-Jo Kim, MD, PhD, of Children's Adolescent and Young Adult Hip Program. "Slips can be triggered in a couple of different ways, such as a rapid increase in body weight or height, or even an injury" says Dr. Kim. "While chronic slips are more common in boys, the more severe, unstable cases tend to occur in girls."
"The tricky thing about slips is that they often manifest themselves with knee pain, when it's really the hip that's injured," he adds. "Patients may have trouble sitting or walking, or even begin to walk with a bit of a limp, like Katie."
Dr. Kim determined Katie would need hip surgery, which she underwent last January. "We are now able to safely dislocate the hip during surgery so that we can work within the joint," he says. "In Katie's case, we used this technique to reposition the femoral head and pin it back into its rightful place, which will help prevent the onset of arthritis in the hip later in life."
Katie's procedure was a great success. After a few months on crutches and a little physical therapy, she was soon walking normally again. "The injury, the surgery—all of it was quite a shock at first, but things are going quite well now," says William.
Katie returned to Children's in late November to have the hardware placed in her hip during the initial surgery removed. Dr. Kim will continue to follow Katie once a year for the time being but says she'll be back to her normal, active lifestyle in just a few short weeks.
