A: A slipped hip, the proper name being Slipped Capital Femoral Epiphysis is a condition most often seen in adolescents. As seen in the diagram, the top portion of the "ball" of the hip joint slips slightly where it is joined to the rest of the leg--at a site called the epiphysis. In most cases it is not caused by any severe trauma but happens spontaneously.

Q: What are the symptoms of Slipped Capital Femoral Epiphysis ?

A: There are no symptoms that are absolutely certain for this condition. However, because it is a serious yet treatable condition, it should be considered in any adolescent with a history of limping, or with pain to the knee or groin.

Q: Can a physician make the diagnosis for certain just on examination of the patient, or are other tests necessary ?

A: Often adolescents with slipped capital femoral epiphysis are found to favor a position of external rotation at the hip (such as sitting cross legged). Moreover, when the hip is moved by the physician, the opposite motion, internal rotation, is often limited. However, confirmation of the diagnosis by Xray is necessary. On Xray the physician may see (1) an obvious slip of the epiphysis and/or (2) formation of new bone growth at the slip site.

Q: How should slipped epiphysis be treated ? I have been told that often the slip itself is not corrected, but that an operation is performed to prevent any more slipping from occuring. Is this true ?

A: It is true that in all cases, further slipping must be prevented. This is done be a hip pinning, which involves an operation to put a screw or nail through the hip bone (femoral head), and into the epiphysis.

The Question of whether or not the slip is corrected, and how this is done is more complex, but in general follows this rough outline. Careful discussion and consultation with an orthopedic surgeon is mandatory.

1. Slip Less Than 30%. The position is usually accepted, and pinned without correction.
2. Slip More Than 30%>
   1. Gentle replacement of the epiphysis back toward the normal position (reduction) may be attempted by placing the patient in general anesthesia, and pulling gently of the leg while providing some internal rotation.
   2. If Manipulation fails to adequately replace the epiphysis, a surgery is often required for reduction.
3. Later Reconstruction may be necessary if the hip heals in a way which does not permit proper function.

Q: What are the potential problems which may occur if this is not properly treated ? Is it always necessary to treat this on an emergency basis?

A: The most dreaded problem associated with slipped capital femoral epiphysis is Avascular Necrosis. Avascular necrosis is a deterioration or death of the epiphysis of the hip joint due to a disturbance of blood flow. In general, this complication is best avoided by: (1) a prompt diagnosis, (2) avoidance of using excessive force to reduce the slip, and (3) proper surgical care.

In addition, because this condition may affect both hips, it is recommended that the other hip is examined by Xray as well.