Slipped Capital Femoral Epiphysis (SCFE) is a hip growth plate injury that usually affects adolescents during rapid growth. It happens when the ball of the hip stays in the socket, but the top of the thigh bone shifts at the growth plate. As a result, children and teenagers may develop hip, groin, thigh, or even knee pain, often with a limp or reduced hip movement.

Because SCFE can present as vague leg pain rather than obvious hip pain, it is sometimes missed early. That matters because delayed diagnosis may increase the risk of worsening slip, ongoing stiffness, and later joint problems. If your child has persistent limping, painful hip rotation, or pain that spreads to the groin or thigh, prompt assessment is important. For broader background, see our guides to hip pain, groin pain, leg pain, and kids sports injuries.

SCFE is different from many other adolescent hip conditions. For example, a younger child with hip stiffness may instead have Perthes disease. A physiotherapist or doctor can help work out which structure is involved and whether urgent imaging is needed. In some teenagers, related symptoms may also overlap with pages such as hip labral tear or femoroacetabular impingement syndrome (FAIS), although SCFE is a distinct growth plate condition that needs medical review.

What is SCFE?

SCFE stands for slipped capital femoral epiphysis. In simple terms, the growth plate near the top of the femur becomes weaker than the forces passing through it. Then the upper femur gradually, or sometimes suddenly, slips out of its normal alignment. Most cases occur during puberty, and the condition is seen more often in growing adolescents.

What causes SCFE?

The exact cause is not always clear. However, SCFE is more likely during periods of rapid growth when the growth plate is more vulnerable. Clinical research also suggests that body weight, hormonal factors, and some endocrine or metabolic conditions may raise risk. Recent evidence highlights obesity as a major risk factor, while hypothyroidism, vitamin D deficiency, and growth hormone use may also contribute in some children.

Some children report a clear incident such as a twist, fall, or awkward step. Even so, many cases build more gradually. Pain may start in the hip, groin, thigh, or knee, and some children simply begin limping or avoiding sport. If pain is felt more through the upper leg, see our broader guide to thigh pain.

Common signs and symptoms

• Hip, groin, thigh, or knee pain
• Limping or reduced ability to walk normally
• Hip stiffness, especially turning the leg inwards
• Pain with running, jumping, or prolonged walking
• Reduced weight-bearing in more severe cases
• One leg appearing to turn out more than the other

These symptoms may overlap with other hip and groin conditions, which is one reason a proper assessment matters. If symptoms are more lateral, some children may instead have irritation around the outer hip such as hip bursitis, while deep groin symptoms may raise different questions such as osteitis pubis.

When is SCFE urgent?

SCFE should be treated as a medical priority, especially if your child suddenly cannot walk or bear weight. An unstable SCFE has a higher risk of complications such as osteonecrosis, which is loss of blood supply to the femoral head. For that reason, sudden severe pain, inability to walk, or a rapid worsening limp should be assessed urgently. If blood supply becomes affected, this may lead to problems similar to avascular necrosis of the femur.

How is SCFE diagnosed?

Diagnosis usually starts with a clinical examination and hip imaging. X-rays are commonly used first. In some cases, further scans may be requested if the diagnosis is unclear or if the treating team wants a closer look at the slip. Midway through your reading, it is worth noting that the NCBI StatPearls overview on SCFE also highlights how often this condition presents with thigh or knee pain rather than obvious hip pain, which is one reason diagnosis can be delayed.

SCFE treatment

Treatment usually requires orthopaedic review and surgery. The common aim is to stabilise the growth plate and prevent further slipping. Many children are treated with in-situ fixation, where a screw is inserted to hold the femoral head in a safer position while the growth plate closes. The exact surgical approach depends on whether the slip is stable or unstable, how severe it is, and whether there are concerns about complications.

Early diagnosis and timely surgery often improve the outlook. However, recovery still takes time, and most children need a gradual plan to restore walking, hip control, strength, and confidence. If your child is moving on from the initial medical stage, our pages on physiotherapy and strength training physiotherapy explain how rehabilitation is usually progressed.

Post-operative rehabilitation

After surgery, your child may need crutches or, in some cases, a wheelchair for a period of protected weight-bearing. The surgeon will guide when it is safe to increase loading. During this phase, rehabilitation often focuses on comfort, gentle movement, and safe day-to-day function. Our post-operative physiotherapy guide explains how structured rehabilitation can support recovery after surgery.

As healing progresses, physiotherapy may help with:

• education about safe activity levels and pacing
• gait retraining as weight-bearing improves
• gentle hip mobility where appropriate
• progressive hip and trunk strength
• balance and movement control
• a graded return to school sport and recreation

Later-stage rehab often includes progressive control and strengthening work for the hip and pelvis. These programs may draw on principles similar to those used in hip stability and deep hip rotator exercises, hip strengthening exercises, and balance exercises, although the exact timing and exercise choice must match the surgeon’s advice and your child’s recovery stage.

People also ask: can SCFE cause knee pain?

Yes. SCFE can refer pain to the thigh or knee, which is why some children do not complain much about their hip at first. If knee pain appears alongside limping, reduced hip rotation, or groin discomfort, the hip should still be assessed. This pattern is also one reason some teenagers first present through a general knee sports injury pathway before the hip is examined more closely.

What to do next

If you suspect SCFE, arrange urgent medical assessment rather than trying to push through sport or training. Once your child has been assessed and, where needed, surgically treated, a physiotherapist may help guide the next stage of recovery with safe strength, mobility, and return-to-activity planning. If your teenager is keen to return to sport, our broader sports injury resources may also help explain the graded return process.

FAQs

What age does SCFE usually happen?

SCFE most often affects adolescents during growth spurts, especially in the early teenage years when the growth plate is still open.

Can SCFE happen without a major injury?

Yes. Many cases develop gradually without a major fall or collision. Symptoms often build over time with limping, stiffness, or pain in the hip, thigh, or knee.

Does SCFE always need surgery?

SCFE usually needs orthopaedic management and commonly requires surgery to prevent further slipping and reduce the risk of joint damage.

Can physiotherapy replace surgery for SCFE?

No. Physiotherapy does not replace surgical stabilisation when SCFE is present. However, physiotherapy may play an important role after medical or surgical treatment by helping restore strength, walking, and function.

How long does recovery take after SCFE surgery?

Recovery time varies depending on the severity of the slip, the procedure performed, and how the hip heals. Many children need a staged return to walking, exercise, and sport over weeks to months.

References

1. Cotton EV, Fowler SC, Maday KR. A review of slipped capital femoral epiphysis. JAAPA. 2022;35(12):25-30. View article
2. Cazzulino A, Naqvi U, Green DW, Swarup I. Diagnosis and management of unstable slipped capital femoral epiphysis: a critical analysis review. JBJS Rev. 2021;9(7). View article
3. Zusman NL, Cote MP, Hosseinzadeh P, et al. Quantifying risk factors for slipped capital femoral epiphysis and postslip osteonecrosis. J Pediatr Orthop. 2024;44(1):e49-e55. View article