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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTE1OTYtZm9sbG93dXA=\nDrugs & Diseases > Sports Medicine\nSlipped Capital Femoral Epiphysis Follow-up\nAuthor: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD more...\nSlipped Capital Femoral Epiphysis\nSections Slipped Capital Femoral Epiphysis\nFunctional Anatomy\nAnalgesics/Antipyretics\nFollowing 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.\nRadiographic 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.\nUntreated SCFE may result in progressive deformity and pain, destabilization of the femoral epiphysis, and decreased range of motion of the hip joint.\nAVN 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.\nChondrolysis 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.\nOsteoarthritis 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.\nLeg-length inequality may result from incomplete reduction, AVN, chondrolysis, or secondary coxa vara.\nHardware failure and \"outgrowing\" hardware may cause loss of fixation. Although rare, postoperative infection may occur.\nMost 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.\nKehl DK. Slipped capital femoral epiphysis. Lovell WW, Winter RB, Morrissy RT, Weinstein SL, eds. Lovell & Winter's Pediatric Orthopaedics. 4th ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1996.\nKatz DA. Slipped capital femoral epiphysis: the importance of early diagnosis. Pediatr Ann. 2006 Feb. 35(2):102-11. [Medline].\nLoder RT. Controversies in slipped capital femoral epiphysis. Orthop Clin North Am. 2006 Apr. 37(2):211-21, vii. [Medline].\nFrick SL. Evaluation of the child who has hip pain. Orthop Clin North Am. 2006 Apr. 37(2):133-40, v. [Medline].\nGeorgiadis AG, Zaltz I. Slipped capital femoral epiphysis: how to evaluate with a review and update of treatment. Pediatr Clin North Am. 2014 Dec. 61 (6):1119-35. [Medline].\nPeck DM, Voss LM, Voss TT. Slipped Capital Femoral Epiphysis: Diagnosis and Management. Am Fam Physician. 2017 Jun 15. 95 (12):779-784. [Medline].\nPeterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997 Sep-Oct. 17(5):648-54. [Medline].\nLoder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993 Aug. 75(8):1134-40. [Medline]. [Full Text].\nKlein A, Joplin RJ, Reidy JA, Hanelin J. Roentgenographic features of slipped capital femoral epiphysis. Am J Roentgenol Radium Ther Nucl Med. 1951 Sep. 66(3):361-74. [Medline].\nUglow MG, Clarke NM. The management of slipped capital femoral epiphysis. J Bone Joint Surg Br. 2004 Jul. 86(5):631-5. [Medline].\nCrawford AH. Slipped capital femoral epiphysis. J Bone Joint Surg Am. 1988 Oct. 70(9):1422-7. [Medline]. [Full Text].\nStanitski CL. Acute slipped capital femoral epiphysis: treatment alternatives. J Am Acad Orthop Surg. 1994 Mar. 2(2):96-106. [Medline].\nRoaten J, Spence DD. Complications Related to the Treatment of Slipped Capital Femoral Epiphysis. Orthop Clin North Am. 2016 Apr. 47 (2):405-13. [Medline].\nLehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. 2006 May-Jun. 26(3):286-90. [Medline].\nKelsey JL, Keggi KJ, Southwick WO. The incidence and distrubition of slipped capital femoral epiphysis in Connecticut and Southwestern United States. J Bone Joint Surg Am. 1970 Sep. 52(6):1203-16. [Medline]. [Full Text].\nLoder RT, Schneble CA. Seasonal Variation in Slipped Capital Femoral Epiphysis: New Findings Using a National Children's Hospital Database. J Pediatr Orthop. 2017 Sep 28. [Medline].\nAzzopardi T, Sharma S, Bennet GC. Slipped capital femoral epiphysis in children aged less than 10 years. J Pediatr Orthop B. 2010 Jan. 19(1):13-8. [Medline].\nRiad J, Bajelidze G, Gabos PG. Bilateral slipped capital femoral epiphysis: predictive factors for contralateral slip. J Pediatr Orthop. 2007 Jun. 27(4):411-4. [Medline].\nHagglund G, Hansson LI, Ordeberg G, Sandstrom S. Bilaterality in slipped upper femoral epiphysis. J Bone Joint Surg Br. 1988 Mar. 70(2):179-81. [Medline]. [Full Text].\nBenson EC, Miller M, Bosch P, Szalay EA. A new look at the incidence of slipped capital femoral epiphysis in new Mexico. J Pediatr Orthop. 2008 Jul-Aug. 28(5):529-33. [Medline].\nZupanc 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. 2008 Jun. 28(4):444-51. [Medline].\nBrenkel IJ, Dias JJ, Davies TG, Iqbal SJ, Gregg PJ. Hormone status in patients with slipped capital femoral epiphysis. J Bone Joint Surg Br. 1989 Jan. 71(1):33-8. [Medline]. [Full Text].\nPritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop. 1988 Jul-Aug. 8(4):385-8. [Medline].\nWells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. 1993 Sep-Oct. 13(5):610-4. [Medline].\nZubrow AB, Lane JM, Parks JS. Slipped capital femoral epiphysis occurring during treatment for hypothyroidism. J Bone Joint Surg Am. 1978 Mar. 60(2):256-8. [Medline]. [Full Text].\nDwek JR. The hip: MR imaging of uniquely pediatric disorders. Magn Reson Imaging Clin N Am. 2009 Aug. 17(3):509-20, vi. [Medline].\nTins B, Cassar-Pullicino V, McCall I. The role of pre-treatment MRI in established cases of slipped capital femoral epiphysis. Eur J Radiol. 2008 Apr 23. epub ahead of print. [Medline].\nAronson DD, Carlson WE. Slipped capital femoral epiphysis. A prospective study of fixation with a single screw. J Bone Joint Surg Am. 1992 Jul. 74(6):810-9. [Medline]. [Full Text].\nWard WT, Stefko J, Wood KB, Stanitski CL. Fixation with a single screw for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1992 Jul. 74(6):799-809. [Medline]. [Full Text].\nKocher MS, Bishop JA, Hresko MT, Millis MB, Kim YJ, Kasser JR. Prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis. J Bone Joint Surg Am. 2004 Dec. 86-A(12):2658-65. [Medline]. [Full Text].\nWensaas A, Gunderson RB, Svenningsen S, Terjesen T. Good long-term outcome of the untreated contralateral hip in unilateral slipped capital femoral epiphysis : Forty hips with a mean follow-up of 41 years. J Child Orthop. 2014 Oct. 8(5):367-73. [Medline].\nKohno Y, Nakashima Y, Kitano T, Irie T, Kita A, Nakamura T, et al. Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study. J Orthop Sci. 2016 Sep 11. [Medline].\nWeiner 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. 1984 Mar. 4(2):145-52. [Medline].\nBetz RR, Steel HH, Emper WD, Huss GK, Clancy M. Treatment of slipped capital femoral epiphysis. Spica-cast immobilization. J Bone Joint Surg Am. 1990 Apr. 72(4):587-600. [Medline]. [Full Text].\nWitbreuk MM, Bolkenbaas M, Mullender MG, Sierevelt IN, Besselaar PP. The results of downgrading moderate and severe slipped capital femoral epiphysis by an early Imhauser femur osteotomy. J Child Orthop. 2009 Sep 26. [Medline]. [Full Text].\nAbu Amara S, Cunin V, Ilharreborde B, French Society of Pediatric Orthopaedics (SOFOP). Severe slipped capital femoral epiphysis: A French multicenter study of 186 cases performed by the SoFOP. Orthop Traumatol Surg Res. 2015 Jul 24. [Medline].\nPerry DC, Metcalfe D, Lane S, Turner S. Childhood Obesity and Slipped Capital Femoral Epiphysis. Pediatrics. 2018 Nov. 142 (5):[Medline].\nA Klein line is a line drawn along the superior border of the femoral neck that would normally pass through a portion of the femoral head. If not, slipped capital femoral epiphysis is diagnosed.\nX-ray of a hip following operative percutaneous fixation of a slipped capital femoral epiphysis.\nKevin D Walter, MD, FAAP Associate Professor, Department of Orthopaedic Surgery, Medical College of Wisconsin; Program Director, Children's Hospital of Wisconsin Pediatric and Adolescent Primary Care Sports Medicine\nKevin D Walter, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine\nDavid Y Lin, MD Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic\nDavid Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons\nEvan Schwartz, MD Director of Orthopedic Surgery, St John's Queens Hospital, New York Medical College; Assistant Professor, Department of Surgery, Albert Einstein School of Medicine\nEvan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine\nCraig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin\nCraig 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\nAnthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College\nAnthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society\nDisclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.\nThe authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Henry Marano, MD, to the development and writing of this article.\nencoded search term (Slipped Capital Femoral Epiphysis) and Slipped Capital Femoral Epiphysis\nImaging in Slipped Capital Femoral Epiphysis\nSlipped Capital Femoral Epiphysis Surgery\nPediatric Limp\nLegg-Calve-Perthes Disease in Emergency Medicine\nLimping Child\nA 7-Year-Old Boy With Left Hip and Knee Pain\nVirtual Reality: A New Reality for Orthopedic Surgery\nCommon Techniques Useful to the Practicing or Training Orthopaedic Surgeon on Call in a Pediatric Hospital\nManagement of Pediatric Femoral Neck Fracture\nDeteriorating Mobility in a 9-Year-Old: Case Presentation\nAccording to Orthopedists\nPrevention of Secondary Fractures in Elderly With Hip or Vertebral Fracture Clinical Practice Guidelines (2019)\nManagement of the Irreparable Rotator Cuff Tear\nHamstring Injuries in Athletes: Evidence-Based Treatment\nVitamin D Needs Calcium to Help Lower Fracture Risk\nDiagnosis and Treatment of Osteoporosis\n2002 1248422-overview Procedures\nProcedures Slipped Capital Femoral Epiphysis Surgery\n2002 91596-overview Diseases & Conditions\nDiseases & Conditions Slipped Capital Femoral Epiphysis\nDiseases & Conditions Imaging in Slipped Capital Femoral Epiphysis\nProcedures Hip Resurfacing"