Child Orthopedics

Frequently Asked Questions

We've been advised by our pediatrician and an orthopedic surgeon that our son needs surgery right away. He has a hip problem where the growth plate has slipped backwards in the hip. We'd really like to know what happens if we don't have the operation done?

Slipped capital femoral epiphysis (SCFE) is a condition that causes the growth center of the hip (the capital femoral epiphysis) to slip backwards on the top of the femur (the thighbone).

If untreated this can lead to serious problems in the hip joint later in life. Fortunately, if recognized and treated early, complications can be avoided or reduced. Surgery is usually necessary to stabilize the hip and keep the epiphysis from slipping even more.

One reason treatment to arrest or stop this condition from getting worse AND to realign the hip in a normal position is to avoid hip deformity. The more slippage, the more likely there will be problems later in life. Abnormal load through or around the hip can also cause a stress fracture.

Children who are overweight are more prone to developing SCFE. This suggests that the main cause of SCFE is from increased force on the hip at a time when the femoral head is not quite ready to support these forces. If your child is overweight or obese, your doctors' recommendations are all the more important.

Even with surgery, problems can occur. One potential complication is chondrolysis. In this condition, the articular cartilage of the hip joint is destroyed. Articular cartilage is the smooth material that covers the joint surface. It is unclear why this develops. This condition results in a painful, stiff hip.

The other possible complication is called avascular necrosis (AVN). This usually occurs when the blood vessels that provide blood to the epiphysis are damaged, torn, or pinched. The result is that the epiphysis dies and becomes further deformed. AVN can lead to early arthritis in the hip joint.

Ryan C. Goodwin, MD, et al. Abductor Length Alterations in Hips with SCFE Deformity. In Clinical Orthopaedics and Related Research. January 2007. No. 454. Pp. 163-168.

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