Slipped Capital Femoral Epiphysis (SCFE)
SCFE can cause hip, thigh or knee pain, limping and reduced hip movement in adolescents.
Quick Answer
Slipped capital femoral epiphysis (SCFE) is an adolescent hip condition in which the upper thigh bone moves through a weakened growth plate. It is usually called slipped upper femoral epiphysis (SUFE) in Australia.
Symptoms may include hip, groin, thigh or knee pain, limping, reduced hip movement or an outward-turned leg. Suspected SCFE needs urgent medical and orthopaedic assessment.
Seek Urgent Medical Assessment if SCFE Is Suspected
Do not encourage the child to keep walking, exercise, stretch the hip or test whether they can push through the pain.
Keep the child off the affected leg and arrange assessment through a hospital emergency department or local on-call orthopaedic service. SCFE requires surgical stabilisation and is not a condition that physiotherapy can manage before medical treatment.
Call 000 when severe pain, injury or another medical emergency makes safe transport difficult.
SCFE can be missed because adolescents do not always describe pain directly in the hip. Some first report vague thigh pain, knee pain, a new limp or difficulty participating in sport. Therefore, clinicians should consider the hip when an adolescent has unexplained knee or upper-leg symptoms.
Early recognition matters because continued loading may allow the slip to worsen. Delayed diagnosis may increase the risk of hip stiffness, altered joint shape and longer-term joint problems.
Physiotherapy Comes After Medical Treatment
The booking pathway below is intended for rehabilitation after orthopaedic assessment and surgery. Do not book routine physiotherapy instead of urgent medical care when SCFE is suspected.
What Are the Symptoms of SCFE?
SCFE symptoms may begin gradually over weeks or months. Alternatively, pain and walking difficulty may worsen suddenly. Symptoms often affect one hip, although both hips can be involved.
Pain
- hip or groin pain
- upper-thigh pain
- pain referred to the knee
- pain during walking or activity
Walking Changes
- a new or worsening limp
- difficulty bearing weight
- reduced walking tolerance
- avoiding sport or physical activity
Hip Changes
- reduced inward hip rotation
- the leg or foot turning outwards
- hip stiffness
- one leg appearing shorter
A child may still have SCFE without severe hip pain. In particular, knee pain combined with a limp or reduced hip movement should prompt assessment of the hip.
What Is Slipped Capital Femoral Epiphysis?
The hip is a ball-and-socket joint. The ball is the femoral head at the top of the thigh bone. During growth, a growth plate separates the femoral head from the femoral neck and shaft.
In SCFE, the growth plate becomes unable to withstand the forces passing through it. The femoral head generally remains within the hip socket while the femoral neck and shaft move relative to it. This changes the alignment and shape of the upper femur.
How SCFE Develops
1. Vulnerable Growth Plate
The adolescent growth plate becomes more vulnerable during rapid growth.
2. Repeated Load
Normal standing, walking and activity place forces through the upper femur.
3. Loss of Alignment
The femoral neck and shaft move relative to the femoral head through the growth plate.
What Causes SCFE?
SCFE usually has no single cause. Instead, growth, mechanical loading and individual health factors may combine to weaken the growth plate.
Recognised risk factors include:
- rapid adolescent growth
- higher body weight
- endocrine or metabolic conditions
- hypothyroidism
- growth hormone treatment in some children
- kidney disease and related metabolic changes
Some adolescents report a fall, twist or awkward step before symptoms become obvious. However, many cases develop without one clear injury.
Risk factors do not confirm the diagnosis. Likewise, an adolescent does not need to have every recognised risk factor to develop SCFE.
How Is SCFE Diagnosed?
Diagnosis starts with the child’s symptom history and an examination by a doctor. The clinician may assess walking, resting leg position and hip movement. A typical finding is reduced inward hip rotation, although examination should remain cautious when SCFE is suspected.
X-rays of both hips usually provide the first imaging assessment. The medical team may request further imaging when symptoms strongly suggest SCFE but initial X-rays do not clearly show a slip.
Do Not Repeatedly Test a Painful Hip
Parents, coaches and clinicians should not repeatedly stretch, rotate or load the hip to see whether symptoms improve. Suspected SCFE requires medical imaging and orthopaedic assessment rather than trial exercise.
How Is SCFE Treated?
SCFE requires orthopaedic treatment and surgical stabilisation. Surgery aims to stop further movement through the growth plate and protect the hip from additional damage.
Many stable slips are treated with fixation in the existing position. A screw is commonly placed across the growth plate to stabilise the femoral head while the growth plate closes. The exact procedure depends on factors such as:
- whether the child can bear weight
- whether the slip is stable or unstable
- the amount of displacement
- blood supply to the femoral head
- the surgeon’s assessment of the other hip
The orthopaedic team will explain the proposed procedure, precautions and follow-up schedule.
Why Is an Unstable SCFE More Serious?
An unstable SCFE generally means that the child cannot walk, even with support. Unstable slips have a greater risk of complications, including disruption to the blood supply of the femoral head.
Reduced blood supply can cause osteonecrosis, also called avascular necrosis of the femur. This is one reason sudden severe pain or inability to bear weight requires immediate assessment.
Can SCFE Affect Both Hips?
SCFE can affect both hips, either at the same time or at different times. The orthopaedic team will assess both sides and explain whether the unaffected hip needs monitoring or preventive treatment.
After treatment to one hip, new pain in the opposite hip, thigh or knee needs prompt medical review.
What Happens After SCFE Surgery?
Recovery instructions vary according to the stability of the slip, the operation and the condition of the femoral head. The surgeon determines when the child may begin or increase weight-bearing.
Early care may involve:
- bed rest or wheelchair use before surgery
- crutches or another mobility aid after surgery
- restricted or protected weight-bearing
- wound care
- pain management
- repeat X-rays and orthopaedic reviews
- temporary restrictions on school and sport
Families should follow the surgical team’s instructions rather than using a generic timeline. An unstable slip, complications or treatment to both hips may require a different recovery pathway.
How Can Physiotherapy Support Recovery?
Physiotherapy may begin after the orthopaedic team confirms that rehabilitation can proceed. The plan should reflect the operation, weight-bearing status, healing stage and any movement restrictions.
Protect and Adapt
Learn mobility-aid use, protect the operated hip and manage school or home activities within surgical restrictions.
Restore Walking and Movement
Progress weight-bearing, walking and approved hip movement when the surgeon confirms that these are safe.
Rebuild Strength and Control
Develop hip, thigh and trunk strength, balance and lower-limb control through a staged program.
Return to Activity
Gradually restore school, recreation and sport after clinical review and appropriate functional testing.
Rehabilitation may include gait retraining, progressive strengthening, balance exercises and activity-specific preparation. However, exercise selection must follow the surgeon’s precautions. Children should not begin generic online hip exercises without clearance.
Learn more about medically guided post-operative physiotherapy.
When Can a Child Return to School?
Return to school depends on pain, mobility, transport, access around the school and the surgeon’s restrictions. Some children may return while using crutches or a wheelchair. Others need more time at home.
A practical school plan may address:
- safe transport and drop-off access
- lifts or alternatives to stairs
- extra time between classrooms
- permission to sit during assemblies
- temporary exclusion from physical education
- help carrying books or equipment
When Can a Child Return to Sport?
Return to sport should not follow time alone. The orthopaedic team must first confirm adequate healing and clarify whether contact sport remains restricted.
Later, return-to-sport decisions may consider:
- medical and imaging clearance
- comfortable walking and stairs
- adequate hip movement for the activity
- restored lower-limb strength
- balance and movement control
- tolerance of graded running or sport drills
- confidence without a symptom flare
Some children need longer-term activity modification because the shape of the hip can remain altered after SCFE.
Could the Symptoms Be Caused by Something Else?
Not every adolescent limp is caused by SCFE. Other conditions can produce hip, thigh or knee symptoms. However, these alternatives should not delay urgent assessment when SCFE is possible.
Perthes Disease
Perthes disease more commonly affects younger children and can cause limping, hip stiffness and referred knee pain.
Femoroacetabular Impingement Syndrome
Femoroacetabular impingement syndrome may cause activity-related groin pain and restricted hip movement in older adolescents or adults.
Infection or Other Illness
Fever, severe constant pain, marked illness or rapidly worsening symptoms require urgent medical assessment.
This comparison does not provide a diagnosis. A doctor may need to assess the child and arrange imaging.
What Should Parents Do Next?
Before Diagnosis or Surgery
Stop sport and weight-bearing. Arrange immediate emergency or orthopaedic assessment. Do not book routine physiotherapy as the first step.
After Surgery and Medical Clearance
Follow the surgeon’s weight-bearing and movement instructions. Physiotherapy may then guide walking, strength, balance and a staged return to school or sport.
Related PhysioWorks Guides
Hip Pain
Learn about other common causes of hip pain and the broader assessment pathway.
Knee Pain
Understand why knee symptoms may sometimes originate from another area, including the hip.
Kids Sports Injuries
Explore injury guidance for growing children and adolescents after serious conditions have been excluded.
Frequently Asked Questions
Is SCFE a medical emergency?
Suspected SCFE requires immediate medical and orthopaedic assessment. All suspected or confirmed cases should be referred to an emergency department or local on-call orthopaedic service, even when symptoms have developed gradually.
Should a child with suspected SCFE keep walking?
No. Keep the child off the affected leg and arrange urgent medical assessment. Do not encourage walking, stretching, exercise or repeated testing of the painful hip.
What age does SCFE usually occur?
SCFE usually occurs during adolescence while the upper femoral growth plate remains open. The exact age varies according to growth and skeletal maturity.
Can SCFE cause knee pain?
Yes. SCFE may refer pain to the thigh or knee. An adolescent with unexplained knee pain, limping or reduced hip movement should have the hip assessed.
Can SCFE happen without a major injury?
Yes. Many cases develop gradually without a major fall or collision. A minor twist or fall may make an existing slip more noticeable, but it is often not the main cause.
Does SCFE always need surgery?
SCFE requires orthopaedic management and surgical stabilisation. Surgery aims to prevent further slipping and reduce the risk of additional joint damage.
Can physiotherapy treat SCFE without surgery?
No. Physiotherapy cannot stabilise the growth plate or replace surgery. It may support recovery after surgical treatment and medical clearance.
When does physiotherapy start after SCFE surgery?
The timing depends on the operation, stability of the slip, weight-bearing restrictions and healing. The orthopaedic team should confirm when physiotherapy and exercise may begin.
Can SCFE affect both hips?
Yes. SCFE can affect both hips at the same time or at different times. New pain in the opposite hip, thigh or knee needs prompt medical review.
How long does recovery take after SCFE surgery?
Recovery varies according to the severity and stability of the slip, the procedure, healing and any complications. Rehabilitation and return to sport often progress over several months rather than following one fixed timeline.
Book Post-Operative Physiotherapy
Once the orthopaedic team has approved rehabilitation, a physiotherapist can help interpret the surgical restrictions and guide a staged return to walking, strength and activity.
Choose your clinic and appointment pathway
Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.
References
- Royal Children’s Hospital Melbourne. Slipped upper femoral epiphysis (SUFE): Emergency Department clinical practice guideline.
- Royal Children’s Hospital Melbourne. Kids Health Info: Slipped upper femoral epiphysis.
- Queensland Health. Slipped upper femoral epiphysis: Clinical Prioritisation Criteria.
- Cotton EV, Fowler SC, Maday KR. A review of slipped capital femoral epiphysis. JAAPA. 2022;35(12):25–30.
- 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).
- 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.
