Everytime we take our son to the orthopedic clinic at Mayo, we hear the same story. He has slipped capital femoral epiphysis. It’s likely he’ll end up with hip arthritis and need a joint replacement. Yadda yadda yadda. What are his chances of this really happening?

Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip most often in teenagers between the ages of 12 and 16. 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 thighbone). Left untreated, this can lead to serious problems in the hip joint later in life.

The very same institution your son has been receiving his care (Mayo Clinic) recently published a study on hip replacement after slipped capital femoral epiphysis (SCFE). They conducted a review of their medical records from 1954 up to 2007. There were 33,000 patients who had hip replacements during that time period. Only 38 were done in hips with degenerative changes or impingement linked with slipped capital femoral epiphysis (SCFE).

A closer look at these patients showed that a severe slip with avascular necrosis was linked most often with the need for joint replacement. There were some patients with SCFE who needed a joint replacement because of impingement rather than degeneration, but the majority were for damage done by the necrosis.

Hip replacement for necrosis occurred early on (mean time was 7.6 years) compared with a delay of over 20 years for patients with joint degeneration or impingement. And the rate of implant failure requiring revision (a second) surgery was fairly high in the necrosis group as well. The reason for implant failure was usually cup loosening or femoral neck fractures. Success of implant revision was good though — 95 per cent of the implants were still in good shape five years later.

The authors say this was the first study of its kind — to show the actual rate of hip replacements in patients who had slipped capital femoral epiphysis (SCFE) as a child. What they uncovered with the study was the understanding that hip replacement following a diagnosis of SCFE occurred most often because of hip necrosis not degenerative hip arthritis.

Many of these patients received all of their care over the years at this Mayo Clinic.

Your son may benefit from the knowledge gained from this study. Future treatment should be focused on preventing avascular necrosis in severely slipped, unstable hips.