Slipped capital femoral epiphysis

A slipped capital femoral epiphysis may affect both hips.

An epiphysis is an area at the end of a long bone. It is separated from the main part of the bone by the growth plate. In this condition, the problem occurs in the upper area while the bone is still growing.

Slipped capital femoral epiphysis occurs in about 2 out of every 100,000 children. It is more common in:

• Growing children ages 11 to 15, especially boys
• Children who are obese
• Children who are growing rapidly

Children with hormone imbalances caused by other conditions are at higher risk for this disorder.

Symptoms include:

• Difficulty walking, walking with a limp that came on quickly with or without trauma
• Knee pain
• Hip pain
• Hip stiffness
• Outward-turning leg
• Restricted hip movements

The health care provider will examine you. A hip or pelvis x-ray can confirm this condition.

Surgery to stabilize the bone with pins or screws will prevent the ball of the hip joint from slipping or moving out of place. At times, the hip joint has to be opened up to allow the surgeon to realign the hip. Some surgeons may suggest using pins on the other hip at the same time. This is because many children will develop this problem in that hip later.

The outcome is most often good with treatment. In rare cases, the hip joint may wear away, despite prompt diagnosis and treatment.

This disorder is linked to a greater risk for osteoarthritis later in life. Other potential but rare complications include reduced blood flow to the hip joint and wearing away of hip joint tissue (avascular necrosis). This can lead to increased pain and stiffness of the joint, even at young age.

If your child has ongoing pain or other symptoms of this disorder, have the child lie down right away and stay still until you get medical help.

Weight control for obese children may be helpful. Many cases are not preventable.

Femoral epiphysis - slipped

Sankar WN, Winell JJ, Horn BD, Wells L. The hip. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 698.

Sawyer JR, Spence DD. Fractures and dislocations in children. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 36.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.