Our son had surgery for a hip problem called SCFE. We thought the surgery was supposed to protect his hip and keep it from dying. The bone collapsed anyway from a lack of blood supply. Why did this happen?

Slipped capital femoral epiphysis (SCFE) 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 thighbone).

Surgery is usually done right away for this problem. Without good placement of the capital femoral epiphysis, loss of blood supply to the area can result in osteonecrosis (death of bone). In fact, six out of 10 children with an unstable SCFE develop osteonecrosis. The long-term effects of osteonecrosis can be very severe.

The best way to avoid this complication is to release the joint capsule. The procedure is known as a decompressive capsulotomy. It can be done just before or right after the slipped epiphysis is put back in place.
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.

But surgeons have found that doing the surgery isn’t a guarantee that everything will be fine. There are problems and complications that can occur. Sometimes the bone slips again. Ischemia (loss of blood supply) can occur resulting in osteonecrosis even after surgery. When that happens, the head of the femur can break into pieces and/or collapse.

Newer studies may help shed some light on these problems. For example, it was once thought that perhaps the surgery to repair the slipped bone brought on the blood loss. But it’s more likely that a build up of pressure inside the joint after it is reduced or manipulated (put back in place) is the main risk factor. High pressures inside the joint cuts off blood circulation to the bone.