Hip, groin, thigh or knee pain in children is often blamed on sports, growth spurts or everyday aches and pains. But sometimes these symptoms can be a sign of a serious hip condition called slipped capital femoral epiphysis (SCFE).
SCFE is one of the most common hip disorders in adolescents. However, it can be difficult to diagnose because the symptoms are often mistaken for other injuries. Early diagnosis and treatment are important to help prevent long-term hip damage and arthritis later in life.
Read how early SCFE diagnosis saved child from debilitating complications of hip disorder
What is SCFE?
SCFE, pronounced SKIFF-ee, is a hip condition that happens when the ball-shaped top of the thighbone, called the femoral head, slips out of its normal position. Sometimes experts describe SCFE as being like a scoop of ice cream slipping off the top of a cone.
The femoral head is connected to the thighbone by a growth plate made of cartilage. When this growth plate weakens or breaks during times of rapid growth such as in the pre-teen years, the femoral head can slip, causing SCFE. Although SCFE is considered a rare condition, it affects about 10.8 out of every 100,000 children.
Who is affected by SCFE?
SCFE most often affects children during puberty who have above-average weight and when they are growing quickly. It typically occurs in children between 8 and 15 years old, but is usually diagnosed in:
- Boys ages 12-13
- Girls ages 11-12
This hip condition is more common in boys than girls. It is also seen more often in African American, Pacific Islander and Latino children, and those with hormone issues.
Are there additional factors that contribute to SCFE?
While SCFE can occur in otherwise healthy children, certain health conditions and treatments can make the hip growth plate more likely to weaken and slip. Risk factors for SCFE include:
- Being obese or overweight, which can place additional stress on the hip growth plate.
- Trauma
- Hormonal disorders, such as thyroid problems or other endocrine conditions.
- Family history of SCFE, suggesting a genetic link.
- Steroid medications and other treatments that can affect bone health.
- Radiation therapy
- Chemotherapy
- Kidney disease, which can lead to bone and growth plate problems.
- The shape and structure of the hip joint.
A minor fall, twist or sports injury can sometimes trigger the final slip, but the growth plate is often already weakened before this happens.
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What are the symptoms of SCFE?
Signs and symptoms of SCFE can develop gradually or appear suddenly. Symptoms may include:
- Hip pain that gets worse with activity and improves with rest.
- Pain in the groin, thigh or knee, even when the hip itself does not hurt.
- A limp or difficulty walking.
- Feeling like the affected leg is weak or "giving out."
- Walking with the foot or leg turned outward.
- A waddling gait, or side-to-side walking pattern.
- Difficulty sitting or standing with the knees facing straight ahead because the knees naturally turn outward.
If you think your child may have SCFE, schedule an appointment with your child's doctor as soon as possible.
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How is SCFE diagnosed?
To diagnose SCFE, your child's doctor will perform a physical exam, review your family's medical history and order imaging or other tests to get a closer look at the hip joint. These tests may include:
- X-rays: This includes anteroposterior scans and frog-leg lateral view scans. Frog-lateral X-rays are a special view of the pelvis and hip joints taken when the patient is in a position that makes their legs look like frog legs.
- Magnetic resonance imaging (MRI)
- Blood tests
Diagnosing SCFE can be challenging because the symptoms are easy to miss. Children may have pain that is not felt in the hip or sometimes no pain at all. When pain is present, it may be diagnosed as a groin strain or pulled muscle. In addition, SCFE can be difficult to detect on X-rays, especially in the early stages because the slip may be very subtle.
It is critical that SCFE is diagnosed and treated promptly to avoid permanent hip damage, reduced mobility and early-onset hip arthritis. In severe cases, a child may eventually need hip reconstruction surgery or a hip replacement later in life.
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If my child is diagnosed with SCFE, what happens next?
If your child is diagnosed with SCFE, they will be asked to stop putting weight on the affected leg even if they don’t have pain. This can help prevent the femoral head from slipping further and reduce the risk of complications.
SCFE is considered an orthopaedic emergency and should be treated as soon as possible. If your child has SCFE on one side of their body, there is an increased risk to the other hip. Doctors carefully monitor both hips when evaluating and treating children with SCFE.
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How is SCFE treated?
Because every case is different, it's important to see a pediatric orthopaedic specialist who can recommend the best treatment for your child. The best approach depends on your child's age, growth and the severity of the slip.
Most children with SCFE need surgery to prevent the hip from slipping further and causing long-term damage. The most common surgery for SCFE uses a small metal screw to stabilize the ball-shaped top of the thighbone and keep it from slipping farther out of place.
Surgeons make a small cut (incision) near your child’s hip. Then the doctor will put a metal screw through the bone and the growth plate in the femoral head. This helps make the bone stable, keeping it from moving farther.
Some children may also be candidates for newer surgical techniques or implants that help reduce the risk of future problems. For younger children, preserving normal growth is an important part of treatment. In some cases, surgeons may use specialized implants designed to support the hip while allowing growth to continue. These newer devices can help reduce the risk of complications, such as differences in leg length or changes in the shape of the femoral head as a child grows.
In some cases, children with more severe slips may need additional surgery to realign or reshape the hip. Early diagnosis can help lessen this risk.
In most cases, children go home within a day after surgery. Physical therapy may be recommended to improve strength, flexibility and range of motion during recovery.
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How does the future look for my child after SCFE?
Treatment for SCFE is highly successful when the condition is diagnosed and treated early. Getting care as soon as symptoms appear can help improve long-term outcomes.
Most children treated for SCFE return to enjoying active lives. After treatment, regular follow-up visits with a pediatric orthopaedic specialist are important. Your child's care team will monitor hip growth, watch for potential complications and help ensure the repaired hip remains healthy and functional through adulthood.
Where can I find expert care for my child with SCFE?
At UC Davis Health, our nationally recognized pediatric orthopaedics team provides expert care for SCFE. We specialize in diagnosing and treating hip conditions in children and work to protect and restore healthy hip function. Through our partnership with Shriners Children's Northern California, families have access to a team of experts and advanced treatment options close to home.
Children benefit from:
- Expert pediatric hip specialists with extensive experience diagnosing and treating SCFE and other complex orthopaedic conditions.
- Advanced imaging technology at locations throughout Northern California to help diagnose SCFE and other pediatric orthopaedic conditions. Experienced radiologists carefully review each image to help ensure an accurate diagnosis and treatment plan.
- Advanced surgical techniques and personalized treatment plans designed to achieve the best possible outcomes.
- Comprehensive care supporting children throughout their growth and development.
- Family-centered care that provides education, guidance and support every step of the way.
- Access to leading research and innovative treatments that help improve outcomes for children with hip disorders.
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This blog was medically reviewed by pediatric orthopaedic surgeon Amanda Whitaker.
