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Slipped Capital Femoral Epiphysis: A Common Disorder Affecting the Adolescent Hip

Deformity, Joint Disease

Shortly after my thirteenth birthday, I had surgery performed on both of my hips as a result of a childhood hip condition called Slipped Capital Femoral Epiphysis. This condition results when the upper end of the thigh bone – the femoral head – becomes displaced and slides down the femoral neck. Slipped Capital Femoral Epiphysis is one of the most common adolescent hip disorders, and it usually manifests itself between the ages of 10 and 16. If caught early, the prognosis is very good. In the earlier stages of the disorder, when the hip has slipped minimally, the hip joint anatomy is still relatively normal. Hip range of motion is generally only minimally affected. In later stages of the disorder, when the hip has slipped to a greater degree, the prognosis is a bit more sketchy. Basically, the greater the degree of slippage of the femoral head, the greater the degree of hip deformity; thus leading to a higher incidence of complications, most notably pain, decreased hip range of motion, and early-onset Degenerative Joint Disease(osteoarthritis). Early detection is key. Any young child or teenager who presents with hip pain, knee pain, or an unexplained limp should be promptly evaluated by an orthopedist to rule out Slipped Capital Femoral Epiphysis. Due to the unique nerve innervation in and around the hip joint, it’s common for this condition to present itself with pain in the knee, and not in the hip.

The standard treatment, which I had performed, is to insert pins or screws across the epiphysis to prevent the femoral head from slipping any further. The pins are normally left in place until the bone attains skeletal maturity, at which point the femoral head is no longer capable of slipping any further. The pins/screws can be removed at this time. The insertion of pins/screws into the hip does not fix the slip itself; rather, it arrests the progression of the slip, but the residual hip deformity remains. In severe cases, a more invasive reconstructive surgery may be required to cut into the femur and reorient the femoral head to a more normal position. In my case, my left hip slipped only a mild degree. My right hip, the painful side, was a moderate/severe slip. The degree of deformity of my left hip was minimal, and as a result, my left hip functions almost like a normal hip. My right hip, due to the more severe nature of the slip, has a greater degree of residual deformity. Thus, I have a limited range of motion in my right hip, as well as chronic pain and stiffness. I have Degenerative Joint Disease, and I will require a hip replacement at some point in the future.

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Thankfully, I am still able to lead a moderately active life. I lift weights, I run occasionally, I hike, and I try to be as active as I can. However, the results of this condition have been hard to contend with. Chronic pain is a daily struggle; the pain varies in intensity but is usually pretty constant. I don’t move as well as I would like for a man of my age(33), and I often feel self-conscious and hesitant due to my hip problems. Even though I walk pretty normally, some days I’m so stiff and achy that it’s hard to even fake a normal walk. But I’m optimistic in terms of the outlook as far as treatment. Hip replacements have come a long way since their beginnings. Hip replacements are lasting longer and longer, and the operation is constantly being refined and updated. But for now, I am in a kind of “wait and see” mode. Most people, if they don’t know my history or if they don’t know what to look for, don’t know that there is anything wrong with my hips. And that is a good thing, I guess. My hip problems have always been a sore spot for me – both literally and figuratively. Life is hard enough without having to contend with a chronic orthopedic condition at such a young age. But I’m optimistic that there will come a time – hopefully soon – when I won’t have to worry about my hips or how they impact my life.