eMedicine Specialties > Sports Medicine > Lower Limb

Slipped Capital Femoral Epiphysis: Follow-up

Author: Kevin D Walter, MD, FAAP, Assistant Professor of Orthopedics and Pediatrics, Department of Pediatric Orthopaedics, Department of Pediatrics, Medical College of Wisconsin; Member of Children's Specialty Group of Children's Hospital of Wisconsin
Coauthor(s): David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic; Evan Schwartz, MD, Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine
Contributor Information and Disclosures

Updated: Aug 25, 2008

Follow-up

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Following fixation of slipped capital femoral epiphysis (SCFE), the patient is given crutches with protected weight bearing for 6-8 weeks. Physical therapy for strengthening, proprioception, balance, and endurance training may be helpful. Most children can then return to full activity once they are pain free with full strength. However, some literature advocates for not allowing a return to contact sports until the physis has closed.

Radiographic follow-up is often continued until physeal closure is achieved to ensure the slippage has not progressed and to ensure there is no contralateral hip involvement. Loss of fixation of the slip can occur but is rare.

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Complications

Untreated SCFE may result in progressive deformity and pain, destabilization of the femoral epiphysis, and decreased range of motion of the hip joint.

AVN of the femoral head is thought to result from vascular damage during the time of the initial traumatic event, but it may result from forceful reduction during the time of surgery. The amount of energy, magnitude of epiphyseal damage and displacement, level of increased intra-articular pressure, and degree of vascular occlusion have been implicated in this process. The risk of AVN is up to 47% with an unstable SCFE. Treatment options are limited (eg, bone grafting, osteotomy to change the position of the femoral head), but often these patients will eventually need a total hip replacement. 

Chondrolysis is the destruction of articular cartilage, which can cause joint space narrowing.  Intra-articular penetration of hardware and violation of the joint has been associated with chondrolysis. It is believed to occur irrespective of the method of treatment; however, chondrolysis has occurred in patients who have not undergone any treatment.

Osteoarthritis is a late complication. There is evidence that increased risk of early degenerative change may result from AVN, chondrolysis, or alterations of the hip biomechanics following slippage. In general, the more severe the deformity and/or SCFE, the higher risk of developing arthritis. Mild deformities may have few consequences. 

Leg-length inequality may result from incomplete reduction, AVN, chondrolysis, or secondary coxa vara.

Hardware failure and "outgrowing" hardware may cause loss of fixation.  Although rare, postoperative infection may occur.

Related Medscape topics:
 Resource Center Joint Disorders
Specialty Site Orthopaedics

Prognosis

Most patients with SCFE who are treated with urgent in situ fixation do well. However, in those cases with severe slippage and resultant deformity, long-term sequelae may result (eg, AVN, chondrolysis, leg-length discrepancy, stiffness, osteoarthritis). Although conservative modalities (eg, therapy, analgesics, orthotics, assistive aids) are used initially for symptomatic relief, urgent operative intervention is indicated. Young patients with unremitting pain, loss of motion, and stiffness secondary to chondrolysis, AVN, or osteoarthritis may require salvage hip arthrodeses. In hips that are incompletely damaged, proximal osteotomies may aid in redirecting the joint forces to less damaged areas of the articular femoral head.

Miscellaneous

Medicolegal Pitfalls

  • AVN of the femoral head: This is believed to be a result of the initial injury and extent of the disease process rather than a result of the operative procedure. Persons with acute slipped capital femoral epiphysis (SCFE) are more at risk of AVN than persons with chronic SCFE. This condition may require further operative intervention in the future.
  • Chondrolysis: This is a devastating complication, usually an iatrogenic result of pin placement within the hip, which may require further operative intervention in the future.
  • Limp
  • Leg-length discrepancy
  • Development of SCFE in the contralateral hip
  • Osteoarthritis

Related Medscape topics
 Resource Center Exercise and Sports Medicine
Resource Center Joint Disorders
Resource Center Medical Malpractice and Legal Issues
Specialty Site Orthopaedics

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Henry Marano, MD, to the development and writing of this article.



More on Slipped Capital Femoral Epiphysis

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Differential Diagnoses & Workup: Slipped Capital Femoral Epiphysis
Treatment & Medication: Slipped Capital Femoral Epiphysis
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Multimedia: Slipped Capital Femoral Epiphysis
References
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References

  1. Kehl DK. Slipped capital femoral epiphysis. In: Lovell WW, Winter RB, Morrissy RT, Weinstein SL, eds. Lovell & Winter's Pediatric Orthopaedics. 4th ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1996.

  2. Katz DA. Slipped capital femoral epiphysis: the importance of early diagnosis. Pediatr Ann. Feb 2006;35(2):102-11. [Medline].

  3. Loder RT. Controversies in slipped capital femoral epiphysis. Orthop Clin North Am. Apr 2006;37(2):211-21, vii. [Medline].

  4. Frick SL. Evaluation of the child who has hip pain. Orthop Clin North Am. Apr 2006;37(2):133-40, v. [Medline].

  5. Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. Sep-Oct 1997;17(5):648-54. [Medline].

  6. Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. Aug 1993;75(8):1134-40. [Medline]. [Full Text].

  7. Klein A, Joplin RJ, Reidy JA, Hanelin J. Roentgenographic features of slipped capital femoral epiphysis. Am J Roentgenol Radium Ther Nucl Med. Sep 1951;66(3):361-74. [Medline].

  8. Uglow MG, Clarke NM. The management of slipped capital femoral epiphysis. J Bone Joint Surg Br. Jul 2004;86(5):631-5. [Medline].

  9. Crawford AH. Slipped capital femoral epiphysis. J Bone Joint Surg Am. Oct 1988;70(9):1422-7. [Medline]. [Full Text].

  10. Stanitski CL. Acute slipped capital femoral epiphysis: treatment alternatives. J Am Acad Orthop Surg. Mar 1994;2(2):96-106. [Medline].

  11. Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. May-Jun 2006;26(3):286-90. [Medline].

  12. Riad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. Jun 2007;27(4):411-4. [Medline].

  13. Hägglund G, Hansson LI, Ordeberg G, Sandström S. Bilaterality in slipped upper femoral epiphysis. J Bone Joint Surg Br. Mar 1988;70(2):179-81. [Medline]. [Full Text].

  14. Benson EC, Miller M, Bosch P, Szalay EA. A new look at the incidence of slipped capital femoral epiphysis in new Mexico. J Pediatr Orthop. Jul-Aug 2008;28(5):529-33. [Medline].

  15. Zupanc O, Krizancic M, Daniel M, et al. Shear stress in epiphyseal growth plate is a risk factor for slipped capital femoral epiphysis. J Pediatr Orthop. Jun 2008;28(4):444-51. [Medline].

  16. Brenkel IJ, Dias JJ, Davies TG, Iqbal SJ, Gregg PJ. Hormone status in patients with slipped capital femoral epiphysis. J Bone Joint Surg Br. Jan 1989;71(1):33-8. [Medline]. [Full Text].

  17. Pritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop. Jul-Aug 1988;8(4):385-8. [Medline].

  18. Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. Sep-Oct 1993;13(5):610-4. [Medline].

  19. Zubrow AB, Lane JM, Parks JS. Slipped capital femoral epiphysis occurring during treatment for hypothyroidism. J Bone Joint Surg Am. Mar 1978;60(2):256-8. [Medline]. [Full Text].

  20. Tins B, Cassar-Pullicino V, McCall I. The role of pre-treatment MRI in established cases of slipped capital femoral epiphysis. Eur J Radiol. Apr 23 2008;epub ahead of print. [Medline].

  21. Aronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am. Jul 1992;74(6):810-9. [Medline]. [Full Text].

  22. Ward WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital femoral epiphysis. J Bone Joint Surg Am. Jul 1992;74(6):799-809. [Medline]. [Full Text].

  23. Kocher MS, Bishop JA, Hresko MT, et al. Prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis. J Bone Joint Surg Am. Dec 2004;86-A(12):2658-65. [Medline]. [Full Text].

  24. Weiner DS, Weiner S, Melby A, Hoyt WA Jr. A 30-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis. J Pediatr Orthop. Mar 1984;4(2):145-52. [Medline].

  25. Betz RR, Steel HH, Emper WD, Huss GK, Clancy M. Treatment of slipped capital femoral epiphysis. Spica-cast immobilization. J Bone Joint Surg Am. Apr 1990;72(4):587-600. [Medline]. [Full Text].

  26. Al-Nammari SS, Tibrewal S, Britton EM, Farrar NG. Management outcome and the role of manipulation in slipped capital femoral epiphysis. J Orthop Surg (Hong Kong). Apr 2008;16(1):131; author reply 131-2. [Medline].

  27. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. Dec 1986;213:20-33. [Medline].

  28. Kelsey JL, Keggi KJ, Southwick WO. The incidence and distribution of slipped capital femoral epiphysis in Connecticut and Southwestern United States. J Bone Joint Surg Am. Sep 1970;52(6):1203-16. [Medline]. [Full Text].

  29. Krahn TH, Canale ST, Beaty JH, Warner WC, Lourenço P. Long-term follow-up of patients with avascular necrosis after treatment of slipped capital femoral epiphysis. J Pediatr Orthop. Mar-Apr 1993;13(2):154-8. [Medline].

  30. Rubin LE, Galante NJ, Smith BG, DeLuca PA. Direct intraosseous pressure monitoring of the femoral head during surgery for slipped capital femoral epiphysis. Orthopedics. Jul 2008;31(7):663-6. [Medline].

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Further Reading

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Keywords

slipped capital femoral epiphysis, hip pain, pain in hip, hip joint pain, SCFE, slipped epiphysis, femoral pain, hip disorder, slipped hip, adolescent hip disorder, femoral head displacement, Salter-Harris physeal fracture, Salter-Harris fracture, femoral head avascular necrosis

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Contributor Information and Disclosures

Author

Kevin D Walter, MD, FAAP, Assistant Professor of Orthopedics and Pediatrics, Department of Pediatric Orthopaedics, Department of Pediatrics, Medical College of Wisconsin; Member of Children's Specialty Group of Children's Hospital of Wisconsin
Kevin D Walter, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic
David Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Evan Schwartz, MD, Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine
Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, Medical Director, Center for Sports Medicine, O'Connor Hospital; Private Practice
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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