Abstract
Background
Obesity is a risk factor for developing slipped capital femoral epiphysis (SCFE). The long-term outcome after SCFE treatment depends on the severity of residual hip deformity and the occurrence of complications, mainly avascular necrosis (AVN). Femoroacetabular impingement (FAI) is associated with SCFE-related deformity and dysfunction in both short and long term.
Questions/Purposes
We examined obesity prevention, early diagnosis, reducing AVN and hip deformity as strategies to reduce SCFE prevalence, and the long-term outcomes after treatment.
Methods
A search of the literature using the PubMed database for the key concepts SCFE and treatment, natural history, obesity, and prevalence identified 218, 15, 26, and 49 abstracts, respectively.
Where Are We Now?
A correlation between rising childhood obesity and increasing incidence of SCFE has been recently reported. Residual abnormal morphology of the proximal femur is currently believed to be the mechanical cause of FAI and early articular cartilage damage in SCFE.
Where Do We Need to Go?
Reducing the increasing prevalence rate of SCFE is important. Treatment of SCFE should aim to reduce AVN rates and residual deformities that lead to FAI to improve the long-term functional and clinical outcomes.
How Do We Get There?
Implementing public health policies to reduce childhood obesity should allow for SCFE prevalence to drop. Clinical trials will evaluate whether restoring the femoral head-neck offset to avoid FAI along with SCFE fixation allows for cartilage damage prevention and lower rates of osteoarthritis. The recently described surgical hip dislocation approach is a promising technique that allows anatomic reduction with potential lower AVN rates in the treatment of SCFE.
Similar content being viewed by others
References
Abraham E, Garst J, Barmada R. Treatment of moderate to severe slipped capital femoral epiphysis with extracapsular base-of-neck osteotomy. J Pediatr Orthop. 1993;13:294–302.
Agamanolis DP, Weiner DS, Lloyd JK. Slipped capital femoral epiphysis: a pathological study. I. A light microscopic and histochemical study of 21 cases. J Pediatr Orthop. 1985;5:40–46.
Allen CP, Calvert PT. Simultaneous slipped upper femoral epiphysis in identical twins. J Bone Joint Surg Br. 1990;72:928–929.
Aronson J, Tursky EA. The torsional basis for slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:37–42.
Barmada R, Bruch RF, Gimbel JS, Ray RD. Base of the neck extracapsular osteotomy for correction of deformity in slipped capital femoral epiphysis. Clin Orthop Relat Res. 1978;132:98–101.
Bartonicek J, Vavra J, Bartoska R. Operative treatment of avascular necrosis of the femoral head after slipped capital femoral epiphysis. Arch Orthop Trauma Surg. 2011;131:497–502.
Bellemans J, Fabry G, Molenaers G, Lammens J, Moens P. Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop B. 1996;5:151–157.
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. 2008;28:529–533.
Bhatia NN, Pirpiris M, Otsuka NY. Body mass index in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2006;26:197–199.
Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Joint Surg Am. 1981;63:85–95.
Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1991;73:667–674.
Chung SM, Batterman SC, Brighton CT. Shear strength of the human femoral capital epiphyseal plate. J Bone Joint Surg Am. 1976;58:94–103.
Dodds MK, McCormack D, Mulhall KJ. Femoroacetabular impingement after slipped capital femoral epiphysis: does slip severity predict clinical symptoms? J Pediatr Orthop. 2009;29:535–539.
Dunbar J, Goulding A. Slipped capital femoral epiphysis: more New Zealand cases likely as obesity rises in children and adolescents? N Z Med J. 2001;114:559–560.
Eisenstein A, Rothschild S. Biochemical abnormalities in patients with slipped capital femoral epiphysis and chondrolysis. J Bone Joint Surg Am. 1976;58:459–467.
Engelhardt P. [Natural course of epiphysiolysis of the femur head] [in German]. Orthopade. 1994;23:195–199.
Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.
Fahey JJ, O’Brien ET. Acute slipped capital femoral epiphysis: review of the literature and report of ten cases. J Bone Joint Surg Am. 1965;47:1105–1127.
Falciglia F, Aulisa AG, Giordano M, Boldrini R, Guzzanti V. Slipped capital femoral epiphysis: an ultrastructural study before and after osteosynthesis. Acta Orthop. 2010;81:331–336.
Fishkin Z, Armstrong DG, Shah H, Patra A, Mihalko WM. Proximal femoral physis shear in slipped capital femoral epiphysis—a finite element study. J Pediatr Orthop. 2006;26:291–294.
Fraitzl CR, Kafer W, Nelitz M, Reichel H. Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br. 2007;89:1592–1596.
Fraitzl CR, Nelitz M, Cakir B, Kafer W, Reichel H. [Transfixation in slipped capital femoral epiphysis: long-term evidence for femoro-acetabular impingement] [in German]. Z Orthop Unfall. 2009;147:334–340.
Futami T, Kasahara Y, Suzuki S, Seto Y, Ushikubo S. Arthroscopy for slipped capital femoral epiphysis. J Pediatr Orthop. 1992;12:592–597.
Galbraith RT, Gelberman RH, Hajek PC, Baker LA, Sartoris DJ, Rab GT, Cohen MS, Griffin PP. Obesity and decreased femoral anteversion in adolescence. J Orthop Res. 1987;5:523–528.
Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.
Ganz R, Huff TW, Leunig M. Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application. Instr Course Lect. 2009;58:241–255.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am. 1986;68:1000–1007.
Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997;79:1489–1497.
Hagglund G, Hansson LI, Ordeberg G. Epidemiology of slipped capital femoral epiphysis in southern Sweden. Clin Orthop Relat Res. 1984;191:82–94.
Imhauser G. [Late results of Imhauser’s osteotomy for slipped capital femoral epiphysis (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1977;115:716–725.
Jones JR, Paterson DC, Hillier TM, Foster BK. Remodelling after pinning for slipped capital femoral epiphysis. J Bone Joint Surg Br. 1990;72:568–573.
Kelsey JL. Epidemiology of slipped capital femoral epiphysis: a review of the literature. Pediatrics. 1973;51:1042–1050.
Kelsey JL, Acheson RM, Keggi KJ. The body build of patients with slipped capital femoral epiphysis. Am J Dis Child. 1972;124:276–281.
Kitadai HK, Milani C, Nery CA, Filho JL. Wiberg’s center-edge angle in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 1999;19:97–105.
Kocher MS, Bishop JA, Weed B, Hresko MT, Millis MB, Kim YJ, Kasser JR. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics. 2004;113:e322–325.
Krahn TH, Canale ST, Beaty JH, Warner WC, Lourenco P. Long-term follow-up of patients with avascular necrosis after treatment of slipped capital femoral epiphysis. J Pediatr Orthop. 1993;13:154–158.
Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics. 2003;112:424–430.
Larson AN, McIntosh AL, Trousdale RT, Lewallen DG. Avascular necrosis most common indication for hip arthroplasty in patients with slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:767–773.
Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. 2006;26:286–290.
Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–375.
Leunig M, Fraitzl CR, Ganz R. [Early damage to the acetabular cartilage in slipped capital femoral epiphysis. Therapeutic consequences] [in German]. Orthopade. 2002;31:894–899.
Leunig M, Horowitz K, Manner H, Ganz R. In situ pinning with arthroscopic osteoplasty for mild SCFE: a preliminary technical report. Clin Orthop Relat Res. 2010;468:3160–3167.
Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol. 2007;19:389–410.
Litchman HM, Duffy J. Slipped capital femoral epiphysis: factors affecting shear forces on the epiphyseal plate. J Pediatr Orthop. 1984;4:745–748.
Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop Relat Res. 1996;322:8–27.
Loder RT. A worldwide study on the seasonal variation of slipped capital femoral epiphysis. Clin Orthop Relat Res. 1996;322:28–36.
Loder RT, Aronson DD, Bollinger RO. Seasonal variation of slipped capital femoral epiphysis. J Bone Joint Surg Am. 1990;72:378–381.
Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am. 1993;75:1141–1147.
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. 1993;75:1134–1140.
Loder RT, Starnes T, Dikos G, Aronsson DD. Demographic predictors of severity of stable slipped capital femoral epiphyses. J Bone Joint Surg Am. 2006;88:97–105.
Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop. 1995;15:349–356.
Lubicky JP. Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:162–167.
Mamisch TC, Kim YJ, Richolt JA, Millis MB, Kordelle J. Femoral morphology due to impingement influences the range of motion in slipped capital femoral epiphysis. Clin Orthop Relat Res. 2009;467:692–698.
Manoff EM, Banffy MB, Winell JJ. Relationship between body mass index and slipped capital femoral epiphysis. J Pediatr Orthop. 2005;25:744–746.
McPherson ME, Homer CJ. Policies to support obesity prevention for children: a focus on of early childhood policies. Pediatr Clin North Am. 2011;58:1521–1541.
Mickelson MR, Ponseti IV, Cooper RR, Maynard JA. The ultrastructure of the growth plate in slipped capital femoral epiphysis. J Bone Joint Surg Am. 1977;59:1076–1081.
Millis MB, Novais EN. In situ fixation for slipped capital femoral epiphysis: perspectives in 2011. J Bone Joint Surg Am. 2011;93(Suppl 2):46–51.
Mirkopulos N, Weiner DS, Askew M. The evolving slope of the proximal femoral growth plate relationship to slipped capital femoral epiphysis. J Pediatr Orthop. 1988;8:268–273.
Morscher E. Strength and morphology of growth cartilage under hormonal influence of puberty. Animal experiments and clinical study on the etiology of local growth disorders during puberty. Reconstr Surg Traumatol. 1968;10:3–104.
Murray AW, Wilson NI. Changing incidence of slipped capital femoral epiphysis: a relationship with obesity? J Bone Joint Surg Br. 2008;90:92–94.
Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–824.
Nguyen AR, Ling J, Gomes B, Antoniou G, Sutherland LM, Cundy PJ. Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia. J Bone Joint Surg Br. 2011;93:1416–1423.
Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev. 2003;24:668–693.
Parsch K, Weller S, Parsch D. Open reduction and smooth Kirschner wire fixation for unstable slipped capital femoral epiphysis. J Pediatr Orthop. 2009;29:1–8.
Peterson MD, Weiner DS, Green NE, Terry CL. Acute slipped capital femoral epiphysis: the value and safety of urgent manipulative reduction. J Pediatr Orthop. 1997;17:648–654.
Poussa M, Schlenzka D, Yrjonen T. Body mass index and slipped capital femoral epiphysis. J Pediatr Orthop B. 2003;12:369–371.
Pritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop. 1988;8:385–388.
Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19:419–424.
Rennie AM. The pathology of slipped upper femoral epiphysis. A new concept. J Bone Joint Surg Br. 1960;42:273–279.
Restrepo R, Reed MH. Impact of obesity in the diagnosis of SCFE and knee problems in obese children. Pediatr Radiol. 2009;39(Suppl 2):S220–225.
Sankar WN, Brighton BK, Kim YJ, Millis MB. Acetabular morphology in slipped capital femoral epiphysis. J Pediatr Orthop. 2011;31:254–258.
Sankar WN, McPartland TG, Millis MB, Kim YJ. The unstable slipped capital femoral epiphysis: risk factors for osteonecrosis. J Pediatr Orthop. 2010;30:544–548.
Schai PA, Exner GU, Hansch O. Prevention of secondary coxarthrosis in slipped capital femoral epiphysis: a long-term follow-up study after corrective intertrochanteric osteotomy. J Pediatr Orthop B. 1996;5:135–143.
Sink EL, Zaltz I, Heare T, Dayton M. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis. J Pediatr Orthop. 2010;30:26–30.
Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg Am. 2010;92:2898–2908.
Song KS, Oh CW, Lee HJ, Kim SD. Epidemiology and demographics of slipped capital femoral epiphysis in Korea: a multicenter study by the Korean Pediatric Orthopedic Society. J Pediatr Orthop. 2009;29:683–686.
Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;49:807–835.
Southwick WO. Compression fixation after biplane intertrochanteric osteotomy for slipped capital femoral epiphysis. A technical improvement. J Bone Joint Surg Am. 1973;55:1218–1224.
Stanitski CL, Woo R, Stanitski DF. Acetabular version in slipped capital femoral epiphysis: a prospective study. J Pediatr Orthop B. 1996;5:77–79.
Stanitski CL, Woo R, Stanitski DF. Femoral version in acute slipped capital femoral epiphysis. J Pediatr Orthop B. 1996;5:74–76.
Steiner MM. Obesity with slipped femoral epiphysis. Case Rep Child Meml Hosp Chic. 1947;6:1017.
Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Third Open Scientific Meeting of the Hip Society, St Louis, MO, USA: CV Mosby; 1975:212–228.
Tosounidis T, Stengel D, Kontakis G, Scott B, Templeton P, Giannoudis PV. Prognostic significance of stability in slipped upper femoral epiphysis: a systematic review and meta-analysis. J Pediatr. 2010;157:674–680, 680–681.
Weiner D. Pathogenesis of slipped capital femoral epiphysis: current concepts. J Pediatr Orthop B. 1996;5:67–73.
Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop. 1993;13:610–614.
Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467:704–716.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
About this article
Cite this article
Novais, E.N., Millis, M.B. Slipped Capital Femoral Epiphysis: Prevalence, Pathogenesis, and Natural History. Clin Orthop Relat Res 470, 3432–3438 (2012). https://doi.org/10.1007/s11999-012-2452-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-012-2452-y