When the Hip Slips: Understanding Slipped Capital Femoral Epiphysis (SCFE)

Introduction

Slipped Capital Femoral Epiphysis (SCFE) is a major paediatric orthopedic challenge. Its incidence is increasing with childhood obesity.  SCFE is an uncommon cause of adolescent hip pain. In SCFE, the “ball” of the hip slips at the growth plate. This “hip slip” often appears during the growth spurt. Early diagnosis matters. Prompt treatment protects the hip and helps children return to near normal life.

What is SCFE?

SCFE means the top of the thigh bone (femoral head) slides backwards and down. The slide happens through the growth plate. The hip joint then becomes misaligned. Because of this, walking can hurt. In some cases, the pain is felt in the knee, not the hip. That is why knee pain in children must not be ignored.

Who gets SCFE?

SCFE usually affects children aged 10–16. It often occurs during a rapid growth phase. Extra body weight increases risk. Hormonal or endocrine issues can also play a role. A family history may increase risk too. The other hip can slip later as well.

Typical symptoms

• Groin, hip, or knee pain
  
• Limping or outward-turned foot while walking
  
• Stiff hip, especially reduced internal rotation
  
• Pain after sport, then even at rest
  
• In severe cases, the child cannot walk at all
  

If a child has these symptoms, see an orthopaedic surgeon quickly. SCFE is urgent. Delay can lead to more slip and long-term hip damage.

How SCFE is classified

• Stable SCFE: the child can still walk (with or without crutches).
  
• Unstable SCFE: the child cannot walk. This is an emergency.
  

The degree of slip can be mild, moderate, or severe. This grading guides treatment.

How we diagnose SCFE

First, we take a careful history and examine the gait and hip motion. Next, we order hip X-rays of both sides. We usually request a pelvis AP view and a lateral view. Sometimes an MRI is needed to detect early or subtle slips. Clear imaging helps plan safe surgery.

Why early treatment is essential

With slipped capital femoral epiphysis, time matters. The longer the head stays slipped, the higher the risk of cartilage damage, deformity, and early arthritis. In unstable cases, blood supply to the femoral head can be at risk. This can cause avascular necrosis, a serious complication. Therefore, we act fast.

SCFE treatment: in-situ pinning

The standard treatment is in-situ pinning (also called percutaneous screw fixation). We guide one or two screws across the growth plate to hold the femoral head in place. We do not force the head back. Instead, we stabilise it where it is to prevent further slip.

• Stable SCFE: urgent but planned in-situ pinning.
  
• Unstable SCFE: emergency stabilisation with careful handling.

Some children may benefit from prophylactic pinning of the other hip, especially if risks are high (young age, obesity, endocrine issues). Your orthopaedic surgeon will discuss this in detail.

After surgery: recovery and return to activity

• Hospital stay: usually short.
  
• Weight-bearing: often limited at first; crutches are used.

• Physiotherapy: helps regain strength and hip motion.

• School and sport: a gradual return plan is set. Running and impact sports resume only when safe.
  
• Follow-up X-rays: check healing and growth plate closure.
  

Most children do well after timely SCFE surgery. However, long-term follow-up is important.

Possible complications (and how we reduce them)

• Further slip: prevented by early pinning.
  
• Avascular necrosis: risk is higher in unstable SCFE; gentle handling and prompt surgery reduce risk.
  
• Femoroacetabular impingement (FAI): may occur if the head-neck shape changes; monitoring helps detect problems early.
  
• Leg length difference or stiffness: physiotherapy and follow-up help.
  

What parents should watch for

• Teen with new hip pain or knee pain
  
• Limping that lasts more than a few days
  
• Difficulty turning the leg inward
  
• Pain after sport that persists at rest

If these signs appear, seek assessment. Early action protects the hip.

Frequently asked questions

Can SCFE happen in both hips?
 Yes. Up to half of patients may develop SCFE on the other side. Hence, both hips are assessed and monitored.

Is SCFE caused by sports?
 Sport may reveal symptoms, but the core issue is the growth plate weakness during growth spurts.

Will my child return to full activity?
 Most do, especially after in-situ pinning and proper rehab. The timeline varies by severity and stability.

When should we see a paediatric orthopaedic surgeon?
 Immediately if a child cannot walk, or if hip/knee pain and limping persist. SCFE is time-sensitive.

Conclusion

Slipped Capital Femoral Epiphysis (SCFE) is an infrequent but serious cause of hip pain. It can also show up as knee pain in adolescents. Early diagnosis and in-situ pinning give the best chance for a healthy hip. If you notice a limp or persistent pain, seek help from an orthopaedic surgeon without delay. Timely care prevents further slip, protects the joint, and supports a safe return to school and sport.