Slipped Capital Femoral Epiphysis Follow-up

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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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.

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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.

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