Can you tell me the difference between stable and unstable SCFE? My sister’s son has had this condition for a few years and they just told me it went from stable to unstable. What does that mean (literally) and what will it mean for my nephew (the boy with the problem)?

Slipped capital femoral epiphysis (SCFE), it is a condition that affects the hip in teenagers between the ages of 12 and 16 most often. Cases have been reported as early as age nine years old. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur (the thigh bone).

Stable SCFE means the child can put weight on the leg and walk (with or without crutches). Unstable SCFE is defined by the child’s inability to walk with or without crutches due to severe pain. Surgery is usually necessary to stabilize the hip and prevent the situation from getting worse.

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.

Once the epiphysis has closed, slippage will stop. Epiphysis closure occurs when the two areas of bone–the epiphysis and metaphysis–join, or fuse, into one single bone. At that point there is no cartilage growth plate remaining between the two parts of the femur. Surgery usually speeds up the process of epiphysis closure.

When a child has been diagnosed with SCFE, surgery is usually suggested immediately. It’s not clear from your question if your nephew has already had one surgical procedure and then developed an unstable hip. Or if his condition went from stable to unstable before surgery was done.

In either case, the preferred method for stopping the epiphysis from slipping further is to place a large screw into the epiphysis to hold it in place. This screw is placed using a special X-ray machine called a fluoroscope. The fluoroscope allows the surgeon to see an X-ray image on a TV monitor while doing the surgery. In this way, the surgeon is able to accurately place a screw into the epiphysis using a small incision in the side of the thigh.

If there is a serious structural change in the anatomy of the hip, there may need to be further surgery to restore the alignment closer to normal. This procedure is usually not considered until the child is done growing. As a child grows, there will be some remodeling that occurs in the hip joint. This may improve the situation such that further surgery is unnecessary.