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I am in my early 50s now but way back when I was a teenager, I had my left hip pinned to treat slipped capital femoral epiphysis (SCFE). Now I need a hip replacement. How hard is it to work with a hip that isn't the right shape and that has pins in it?

Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip in teenagers most often between the ages of 12 and 16. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips 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, the condition can be treated and the complications avoided or reduced if recognized early. The primary goal of the treatment of SCFE is to stop any further slippage of the capital femoral epiphysis. The less slip, the lower the risk of problems in the hip during the child's life and later as an adult. Surgery (such as you had with pinning) is usually necessary to stabilize the hip and prevent the situation from getting worse. Even with treatment, there can be some important factors to consider when planning a total hip replacement. For example, a past history of slipped capital femoral epiphysis (SCFE) can lead to a position of the femoral head in the hip socket that is offset (off-center). The end-result can be a limb-length difference and early degenerative arthritis of the hip. If there is a leg-length difference, the surgeon can't just take the old hip joint out and put the new implant in. Careful planning and adjusting of the component parts of the implant are important in preventing continuation or even worsening of the leg length discrepancy. When a total hip replacement is needed later in life because of slipped capital femoral epiphysis present at an earlier age, the surgeon must evaluate any and all contributing factors, including functional and structural causes of leg length differences. Special X-rays (teleoroentgenography, scanography) and more advanced imaging studies (CT scans) are taken preoperatively. Careful review of these images provides the surgeon with an appreciation of significant issues (e.g., femoral neck shortening or lengthening, a large femoral offset, excessive coxa vara or twist in the femur). Beware that replacing the hip joint will not change problems lower down in the knee or ankle or higher up in the spine. In the case of limb-length differences, surgical correction can't be predicted or guaranteed -- even with surgical release of tight soft tissues around the hip. Preoperative assessment and surgical techniques today make it possible to remove those pins and replace the hip to give you pain relief and improved joint motion and function. Be sure and talk with your surgeon about what to expect. Ask for specifics about what the hip replacement can and cannot do for you.

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